





^ ^ 

^ ^ 



- .r^ 



£^ 



♦ <k 



.0* 



,V**°d^: 




^0 





















^ :<Poi£Slfe cp\-;-, V o°Vi^% c^ <tf 



&.<* 











^.<* 










■/• 



^ a 









<& 






^; r4t 



<£>> 'v 






-**,. ^ 



■% 



J 



V 

,4 a 

















w 



\V C b. 'o, x^ 










c b 



'' / 



W * 



^w 



». ^ t^ * U _>^ - B. ^. CN « O-'j 








<H Q, 






& °^ 




<h.^o 



6 °* 



:^ °- < 



^ % <** : 













^ <* 






^ : ; %<^ : 






^.o^ 












^o< 











^f^ 









ANSWERS 



TO 



QUESTIONS PRESCRIBED 



BY 



MEDICAL STATE BOARDS 



BY 

ROBERT B. LUDY, M.D., 

LATE ACTING-ASSIST ANT SURG RON, U.S. A. ; LECTURER ON PRACTICE OF MEDICINE IN TEMPLE 

COLLEGE OF PHILADELPHIA ; AUTHOR OF " ANSWEKS TO QUESTIONS PRESCRIBED 

BY DENTaL STATE BOARDS ;" " ANSWERS TO QUESTIONS PRESCRIBED 

BY PHARMACEUTICAL STATE BuAKES," EXC. 



THIRD EDITION, REWRITTEN AND ENLARGED. 



PHILADELPHIA : 

JOHN JOS. McVEY. 

1907 



IjgHAHY of CONGRESS" 
I wo Cooles Received 

OCT 23 190? 

Copyrwrht Entry 

Sk 7 <<?«7 

CLASS A XXC„ No. 
\fc fZ. IT- 
COPY B. 



v^ 



Entered according to the Act of Congress, in the year 1907, 

By JOHN JOS. McVEY, 

In the Office of the Librarian at Washington, D. C. 



si-/ 



PREFACE TO THIRD EDITION. 



The large sale of this work has permitted the early prep- 
aration of a third revision. The entire text has been care- 
fully scrutinized, corrected where necessary, revised and 
abbreviated where improvement could be made, and added 
to by the incorporation of recent examination questions and 
answers. This third edition has been edited throughout by 
Charles Piatt, M. D., Ph. D. Robert B. Ludy. 



PREFACE TO SECOND EDITION. 



The indorsement of the first edition of this book by teach- 
ers and students, as shown by numerous expressions of ap- 
proval, as well as by its rapid sale, is extremely gratifying to 
the author and seems to warrant its continuance. 

All new State Board questions which have appeared since 
the publication of the first edition have been added. It is 
hoped that the careful revision to which the work has been 
subjected has eliminated the errors which appeared in the 
first edition. 

Everything has been sacrificed to brevity and accuracy, so 
that students will find the book indispensable in preparing 
for college, hospital, army and navy examinations in the 
shortest possible time. 

(iii) 



iv PREFACE TO SECOND EDITION. 

Many persons having an adequate knowledge of the sub- 
ject in which they are tested, fail because of their inability to 
interpret properly the intents and purposes of the questions 
to be answered by them. To aid in this, as well as to afford 
a convenient manual for the general preparation of medical 
students in their work, is the sole object of this book. 

Having collected a large number of questions from differ- 
ent states, it was found that duplications occurred ranging 
from 30% to 80%, varying according to the several subjects. 
Thus a comprehensive knowledge of these questions and an- 
swers will serve excellently in the preparation of future ex- 
aminations before such Boards. 

In order to secure a critical interpretation of the questions, 
and concise, yet complete, answers to the same, the author has 
been favored by the assistance of well-known specialists in 
their several lines, whose competence and experience give to 
the work a range and value impossible of attainment in the 
product of a single author. 

To them the author makes grateful acknowledgment. The 
high value of their carefully prepared answers is fully appre- 
ciated by him, and will be by those into whose hands the work 
is committed. Robert B. Ltjdy. 






SPECIAL AUTHORS. 



Herbert L. Northrop, 31. X). 

Professor of Anatomy, and Associate Professor of Surgery in 
the Hahnemann Medical College and Hospital of Philadelphia. 

Wm. Harmar Good, A. 31., 31. D. 

Demonstrator in Physiology at the Medico-Chirurgical College 
of Philadelphia. 

Charles Piatt, A. C, 31. D., Ph. D., F. C. S. Lond. 

Author of Piatt's Medical Chemistry; Member of the Ameri- 
can Chemical Society; Member of the Socieie Chimique de Paris; 
Honorary Fellow of the Society of Biological Chemistry of 
London. 

W. Wayne Babcoch, 31. D. 

Professor of Surgery and Clinical Surgery in Temple College 
of Philadelphia; Assistant Pathologist to the Philadelphia Hos- 
pital, and Joint Author of Vol. V., Cohen's System of Physio- 
logic Therapeutics. 

W. Mersey Thomas, 3r. D. 

Lecturer on Surgery, Medico-Chirurgical College; Assistant 
Surgeon, Medico-Chirurgical Hospital. 

W. A. Newman Borland, 31. D. 

Associate in Gynecology, Philadelphia Polyclinic; Assistant 
Obstetrician, Hospital of the University of Pennsylvania; Au- 
thor of ' ' Modern Obstetrics, ' ' System of American Medical 
Dictionaries, etc. 

Thomas L. CoUy, 31. I). 

Assistant Visiting Physician and Chief of Medical Dispensary, 
Methodist Episcopal Hospital; Associate Editor Therapeutic 
Monthly. 

(v) 



CONTENTS. 

PAGE 

I. Anatomy 9 

By Herbert L. Northrop, M. D. 

II. Physiology 73 

By ¥m. Harmar Good, A. M., M. D. 

III. Hygiene 135 

By Robert B. Ludy, M. D. 

IV. Chemistry 173 

By Charles Piatt, M. D., Ph. D. 

V. Pathology and Bacteriology 307 

By W. Wayne Babcoek, M. D. 

VI. Surgery 339 

By W. Hersey Thomas, M. D. 

VII. Obstetrics and Gynecology 433 

By W. A. Newman Dorland, M. D. 

VIII. Therapeutics and Materia Medica 519 

By Thomas L. Coley, M. D. 

IX. Practice op Medicine 613 

By Robert B. Ludy, M. D. 

(vii) 



ANATOMY. 



What is connective tissue? Where in the body is con= 
nective tissue found? 

Connective, or areolar, tissue consists of branched cells, or 
connective tissue corpuscles, the fibres of which interlace and 
form spaces or areolae. It is freely distributed throughout 
the body, forms sheaths of muscles, blood vessels, nerves, etc., 
binds parts together and forms a generally evenly spread-out 
layer beneath the skin, the superficial fascia. 

Into what and how far from the pyloric orifice of the 
stomach does the ductus communis choledochus normally 
open? 

Into the duodenum upon its concave side (descending por- 
tion) three or four inches below the pyloric orifice. 

Give the course, relations and structure of the ureter. 

Begins in the upper expanded portion, the " pelvis of the 
kidney," passes downward behind the peritoneum upon the 
psoas magnus muscle, over the brim of the pelvis into pelvic 
cavity, forward to base of bladder, between rectum and blad- 
der in male, y 2 inch from cervix in female, then between 
vagina and bladder, terminating at posterior angle of trigone. 
It consists of three coats, fibrous, muscular and mucous. 

What constitutes the brachial plexus? 

The 5th, 6th, 7th and 8th cervical nerves and 1st thoracic 



nerve. 



Mention the ligaments, fissures and lobes of the liver. 

Ligaments are five in number, falciform (suspensory), 
round, coronary, right and left lateral; fissures are five in 

(9) 



10 ANATOMY. 

number, fissure for round ligament (obliterated umbilical 
vein), for gall-bladder, for ductus venosus, for inferior cava, 
and transverse fissure; lobes are five in number, right, left, 
quadrate, Spigelian, caudate. 

Mention the abdominal muscles. Describe any one of 
these muscles. 

External and internal oblique, transversalis, recti, pyra- 
midales. (Quadratus lumborum, psoas magnus and parvus, 
and iliacus might be included.) Internal oblique takes origin 
from outer half of Poupart's ligament, from anterior two- 
thirds of middle lip of iliac crest, from lumbar aponeurosis, 
from last three ribs; is inserted into linea alba and inner 
extremity of ilio-pectineal line behind Gimbernat's ligament. 
Its aponeurosis divides to form sheath of rectus for its upper 
three-fourths, passing in front of rectus for its lower fourth. 
The line of this division of internal oblique is called linea 
semilunaris ; internal oblique unites with transversalis to form 
conjoined tendon. Action is to flex thorax upon pelvis, or 
vice versa, to rotate trunk toward same side, and to compress 
abdominal viscera. 

Locate the principal groups of lymphatic glands. 

Inguinal (superior and inferior), axillary and cervical 
(superficial and deep) . 

Give the anatomy of the true vocal cords. 

Are two in number, formed by crico-thyroid membrane, 
attached to retiring angle of thyroid cartilage anteriorly and 
to vocal process of arytenoid cartilage posteriorly; have 
thyro-arytenoid muscle along their outer side. They are 
covered by mucous membrane, which is closely attached and 
thin, and consisting of stratified, squamous epithelial cells. 

Give the point of opening of the parotid duct, of the 
submaxillary duct and of the sublingual duct. 

Parotid duct, in cheek wall opposite middle upper molar 
tooth; of submaxillary duct, in fraenum linguae; sublingual 
duct, close to f ramum linguae. 



ANATOMY. 11 

Describe the ischiorectal fossae and their contents. 

Are located between the lower part of the rectum and the 
ischial tuberosities; are triangular in shape, bounded inter- 
nally by sphincter ani, levator ani and coccygeus muscles; 
externally by tuberosity of ischium; are filled with adipose 
tissue; in outer wall is internal pudic artery; crossing the' 
space are inferior hemorrhoidal vessels and nerves. 

State origin, course, and distribution of sixth cranial 
nerve. 

Superficial origin, from groove between medulla and pons ; 
course, forward through cavernous sinus, exit from cranial 
cavity by sphenoidal fissure ; distribution to external rectus 
of eye. 

Give the relations of the right kidney. 

Rests upon quadratus lumborum and psoas magnus muscles, 
is in contact with under surface of right lobe of liver, has 
duodenum and ascending colon in front. 

Describe the right ventricle of the heart. 

Is placed mostly upon anterior aspect of heart, does not 
extend to apex, is crescentic in cross-section, contains tricuspid 
valve, which guards right auriculo-ventricular opening, to 
left and front of which is conus arteriosus leading up to pul- 
monary orifice, which is guarded by pulmonary semilunar 
valves, contains columnae earneae. musculi papillares and 
chordae tendinese. 

Describe endothelium. 

Irregular, flattened (squamous) cells, attached edge to edge, 
resting on basement membrane. 

Describe the external carotid artery. 

One of the two terminal branches of common carotid, given 
off at level of upper border of thyroid cartilage, extends up 
neck, passes into parotid gland, where it terminates by divid- 
ing into superficial temporal and internal maxillary arteries. 
Branches are: Ascending pharyngeal, to lateral wall of 



12 ANATOMY. 

pharynx; superior thyroid, to larynx and thyroid body; lin- 
gual, to tongue; facial, to superficial parts of face; occipital, 
to post-cervical and occipital regions ; posterior auricular, to 
external and middle ear; superficial temporal, to scalp; in- 
ternal maxillary, to deep parts of face and by middle menin- 
geal (through foramen spinosum of sphenoid), to inner skull 
wall and dura, 

What muscles form the calf of the leg? Describe any 
one of these muscles. 

Gastrocnemius and soleus. Gastrocnemius takes origin by 
two heads from internal and external condylar ridges of 
femur; these heads unite, join the soleus, thus forming the 
tendo Achillas, which is inserted into the posterior extremity 
of the os calcis. 

Describe the thyroid gland. 

It consists of right and left lobes connected by an isthmus 
across 2d, 3d and 4th rings of trachea; has a capsule and 
trabecule enclosing closed follicles, which contain colloid 
material. 

Give a comprehensive description of any one of the 
long bones of the body. 

The humerus possesses a shaft and two extremities. The 
upper end has a head which is hemispherical and articulates 
with glenoid cavity of scapula. Just below it is the anatom- 
ical neck, to which the capsule of the shoulder- joint is at- 
tached. Then come the greater and lesser tuberosities, serving 
for the attachment of muscles, while below them is the surgical 
neck. The bicipital groove and ridges extend downward 
between the two tuberosities, and also serve for the insertion 
of muscles. Upon the posterior surface of the shaft is the 
musculo-sipiral groove. Rough impressions are found upon 
the outer and inner aspects of the shaft for the deltoid and 
coraco-brachialis muscles respectively. The lower end is ex- 
panded laterally, to receive the radius and ulna, and supports 
the outer and inner condyles. The articular surface is di- 



ANATOMY. 13 

vided into a capitellum externally for the head of the radius, 
and a trochlea internally for the greater sigmoid cavity of 
the ulna. Above the trochlear surface is the coronoid fossa 
anteriorly, and the olecranon fossa posteriorly. 

Into what two great classes are muscles divided? Give 
a macroscopic and a microscopic description of each. 

Voluntary and involuntary. The voluntary muscles num- 
ber about 311 in the body. The fibres are bound into bundles 
by connective tissue (perimysium), and are attached to bones, 
ligaments or integument by bands of white fibrous tissue 
called tendons. The involuntary muscular tissue is found 
throughout the greater part of the wall of the alimentary 
tract, in the walls of the arteries and veins, and in the uterus. 
The microscopic appearance of a voluntary fibre is one that 
is transversely striated, with a sarcolemma (sheath) inclosing 
the sarcous elements. The involuntary fibre is fusiform, is 
longitudinally striated, and possesses a centrally placed 
nucleus. 

Describe the right and the left subclavian vein. 

The right subclavian vein rests on the first rib in front of 
the scalenus anticus muscle, and is a continuation of the 
axillary vein; just below and behind the sterno-clavicular 
joint it unites with the internal jugular vein to form the right 
innominate vein. The left subclavian vein does not differ 
materially from the right; at the junction of subclavian and 
internal jugular on the left side the thoracic duct terminates. 
The subclavian veins receive the blood from the upper ex- 
tremities, shoulders, chest wall and superficial area of face 
and neck. 

Mention the flexor muscles of the forearm and describe 
one of them. 

Flexor carpi radialis, flexor carpi ulnaris, flexor sublimis 
digitorum, flexor profundus digitorum, flexor longus pollicis. 
Flexor profundus digitorum takes origin from upper % of 
shaft of ulna, from coronoid process and from interosseous 



14 ANATOMY. 

membrane; is inserted by 4 tendons into last phalanx of each 
finger ; action, to flex last phalanx. 

Compare aponeuroses with tendons. 

Aponeuroses are broad, flat sheets of fibrous tissue to which 
muscular fibres are attached, serving as tendons of insertion 
for these fibres. Tendons are rounded (cord-like) or narrow 
(ribbon-like) bundles of fibrous tissue attaching muscles to 
bones or forming ligaments of joints (shoulder, hip). 

Give the number of the cervical vertebrae and mention 
the marked characteristics of such of these vertebrae as 
are in any way peculiar. 

Seven. The atlas is a ring with two lateral masses sup- 
porting a superior and an inferior pair of articular processes ; 
it has no spinous process; the axis has an odontoid process 
on the upper surface of its body ; the 7th vertebra has a long 
spine, hence its name, the vertebra prominens. 

Name the bones of the head. 

Occipital, 2 parietals, frontal, 2 temporals, sphenoid, eth- 
moid, 2 nasal, 2 lachrymal, 2 inferior turbinals, vomer, 2 
maxillae, 2 palate, 2 malar, mandible. 

Describe the acetabulum. 

Is formed by union of ilium, ischium and os pubis; has 
horseshoe-shaped articular surface and non-articular depres- 
sion at bottom; cotyloid notch is below and in front; is deep- 
ened by cotyloid ligament in recent state attached to rim. 

Name the seven muscles of the orbit. 

Levator palpebral superioris, superior, inferior, external, 
internal recti, superior and inferior oblique, 

Where is the compressor urethrae muscle? 

Between the two layers of triangular ligament and sur- 
rounds membranous urethra. 

Describe the origin and distribution of the optic nerves. 

They arise from the optic commissure, pass out of cranial 



ANATOMY. 15 

cavity with ophthalmic artery through optic foramen, pierce 
sclerotic and choroid coats of eyeball to nasal side of posterior 
pole and are distributed to retinse. 

What is the solar plexus? 

A neuro-ganglionic collar of the sympathetic nervous system 
surrounding celiac axis, from which nerve trunks accompany 
arterial branches to supply all abdominal viscera. 

Name the foramina at the base of the skull, and the 
structures transmitted through each. 

Foramen magnum : Spinal cord, meninges, spinal accessory 
nerves, vertebral arteries. Posterior condyloid (inconstant) : 
Veins. Anterior condyloid (2) : Hypoglossal nerves. Mas- 
toid : Emiss'ary vein. Internal auditory meatus : Auditory 
and facial nerves, auditory artery. Jugular foramen : Lateral 
and inferior petrosal sinuses, glossopharyngeal, pneumogas- 
tric and spinal accessory nerves. Hiatus Fallopii : Great 
superficial petrosal nerve. Middle lacerated foramen: In- 
ternal carotid artery, sympathetic plexus. Foramen spino- 
sum : Middle meningeal artery. Foramen ovale : Mandibular 
division of sensory root of fifth cranial nerve and motor root 
of fifth. Foramen rotundum: Maxillary division of fifth. 
Vidian canal : Vidian nerve. Optic foramen : Optic nerve 
and ophthalmic artery. Sphenoidal fissure : Motor oculi, 
trochlear and abducens nerves, ophthalmic division of fifth, 
ophthalmic vein. Olfactory foramina : Olfactory nerves. 

Describe the female urethra as to (a) location, (b) 
dimensions, (c) structure. 

Is located anterior to vagina, extending from internal uri- 
nary meatus (neck of bladder) to external urinary meatus 
in vestibule, close to anterior margin of vaginal orifice. It 
is iy 2 inches long and quite dilatable. Is lined with mucous 
membrane (squamous epithelium, stratified) which is thrown 
into longitudinal folds, and is surrounded by an areolar coat 
and by muscular layers containing inner longitudinal and 



16 ANATOMY. 

outer circular fibres, with an abundance of yellow elastic 
tissue and many vessels, especially veins. 

What is contained in the right hypochondriac region? 

Part of right lobe of liver, part of gall-bladder, part of 
ascending colon, hepatic flexure, p f art of right kidney. 

What muscles form the tendo Achillis, and where is the 
tendon inserted? 

Gastrocnemius and soleus; inserted into posterior part of 
os calcis. 

What forms the internal malleolus of the ank!e=joint? 

The lower end of the tibia. 

Describe the bones of the foot, giving their divisions 
and articulations. 

Tarsus consists of os calcis, astragalus, cuboid, scaphoid, 
cuneiform bones (internal, middle and external) ; metatarsus 
consists of five bones; phalanges number fourteen. Astra- 
gulus articulates with tibia, fibula, os calcis, scaphoid. Os 
calcis articulates with astragalus, cuboid. Scaphoid articu- 
lates with astragalus and three cuneiform bones. Cuneiform 
bones articulate with scaphoid behind, with each other lat- 
erally, and with first, second, third and fourth metatarsal 
bones in front. Metatarsals articulate with three cuneiform 
and cuboid behind, with each other, and with first phalanges. 
Phalanges articulate with metatarsals and with each other. 

Name the articulations of the occipital bone. 

Atlas, two piarietals, two temporals, sphenoid. 

What are the special characteristics of the left ven= 
tricle of the heart? 

It forms the apex of the heart ; its wall is thicker than that 
of the right ventricle; its musculi papillares are fewer in 
number and larger; aurieulo-ventricular valve (mitral) is 
made up of two segments. 



ANATOMY. 17 

Describe the auditory apparatus. 

Consists of three divisions, viz., external, middle and in- 
ternal ear. Auricle is attached to temporal bone, is made 
up of elastic 'cartilage, leads into external auditory meatus, 
at bottom of which is obliquely placed membrana tympani. 
Middle ear is narrow cavity in petrous bone, Eustachian 
tube ■connecting it with the naso-pharynx ; mastoid antrum 
is in upper posterior part, leading into mastoid cells ; it is 
lined with mucous membrane. The internal ear consists of 
osseous labyrinth containing membranous labyrinth, and is 
made up of vestibule, cochlea and three semicircular canals. 
To membranous labyrinth auditory nerve is distributed. 

Mention the sutures at the vertex of the skull and state 
what bones they unite. 

Sagittal suture, uniting the two parietal bones; lambdoid, 
uniting occipital with both parietals; coronal, uniting both 
parietals behind with frontal anteriorly. 

Mention and describe the salivary glands. 

Parotid, submaxillary, sublingual. Parotid, largest, placed 
in front of ear, behind ramus of mandible; duct (Steno's) 
passes across masseter muscle, perforates buccinator muscle, 
terminates in cheek wall opposite upper middle molar. Par- 
otid has facial nerve, external carotid artery, temporo-maxil- 
lary vein passing through it. 

Submaxillary gland is located upon inner side of body of 
mandible posteriorly, is crossed by facial artery; duct (Whar- 
ton's) passes forward, terminating close to fraanum linguae. 

Sublingual gland, located in shallow fossa upon inner side 
of body of anandible, near symphysis, is covered by mucous 
membrane of mouth; ducts (Bartholin's) terminate near 
freenum linguae. 

Mention any one muscle which moves the humerus (a) 
forward, (b) backward, (c) inward. 

(a) Coraco-brachialis ; (lb) posterior fibres of deltoid; (c) 
latissimus dorsi. 
2 



18 ANATOMY. 

What would be the collateral circulation if the brachial 
artery were ligated below its profunda branches? 

Superior and inferior profunda above, anastomotica magna,, 
radial and ulnar (anterior and posterior) recurrent below. 

Describe the Meibomian glands. 

Sebaceous glands embedded in posterior surface of tarsal 
plates of eyelids, consisting of single duct with closely at- 
tached acini, orifices of ducts terminating in single row of 
apertures along posterior lid-margin. 

Give location and a description of the tubercula quad= 
rigemina. 

Located upon upper surface of crura cerebri, just behind 
third ventricle and beneath posterior part of velum inter- 
positum ; nates anterior to testes. They consist of gray mat- 
ter externally, white internally, and are connected with bra- 
chia of optic tracts. 

Describe the renal blood circulation. 

Arterial blood enters sinus through hilum by means of renal 
artery, branches of which pass between Malpighian pyramids 
to cortico-medullary junction, where they form transverse 
branches which send arterioles into cortical and medullary 
portions of kidney, forming glomeruli in the former, and 
plexuses around the uriniferous tubules in the latter. The 
veins collect the blood from these parts, form cortico-medul- 
lary branches and pass through medullary portion between 
pyramids, leaving kidney through sinus as renal vein. 

Mention the muscles attached to the great trochanter 
of the femur. 

Gluteus medius and minimus, pyriformis, obturator inter- 
nus, gemellus superior and inferior, obturator externus. 

What arteries, muscles and nerves would be severed in 
a cross=section at the middle of the humerus? 

Brachial, superior and inferior profunda; biceps, triceps,, 



ANATOMY. 19 

insertions of deltoid and coraco-brachialis, origin of brachi- 
alis anticus; musculo-eutaneous, internal cutaneous, median, 
ulnar, musculo-spiral. 

Describe the vagina. 

Begins at vulvar aperture, extends upward and backward 
in axis of outlet of pelvis, surrounds cervix uteri, reaching 
higher up on cervix posteriorly than anteriorly, is lined with 
laminated squamous cells, has large venous plexuses in sub- 
mucosa, contains circular (within) and longitudinal (with- 
out) involuntary muscle fibres. Bladder and urethra are in 
front, rectum is behind. Peritoneum covers upper posterior 
wall. 

Differentiate synarthrosis, amphiarthrosis, and diarth= 
rosis, giving an example of each. 

Synarthrosis is an immovable joint consisting of two bones 
placed edge to edge with little or no fibrous tissue intervening ; 
example, lambdoid suture. Amphiarthrosis is joint permit- 
ting of slight motion, made up of two bones with intervening 
fibro-cartilaginous plate or disk and held together by liga- 
ments; example, joints formed by bodies of vertebrae and 
intervertebral disks. Diarthrosis is freely movable joint, 
consisting of two or more bones with articular surfaces cov- 
ered with hyaline cartilage and surrounded by ligaments lined 
with synovial membrane ; example, hip-joint. 

Describe the shoulder=joint. 

Variety, enarthrodial (ball-and-socket) ; bones, glenoid 
fossa of scapula, head of humerus; ligament, capsular, which 
is intimately blended with tendons of insertion of sub-scapu- 
laris, supraspinatus, infraspinatus and teres minor muscles; 
tendon of long head of biceps passes within capsule over 
humeral head, and is surrounded by synovial membrane; 
movements, flexion, extension, abduction, adduction, rotation 
and circumduction. 

Give the origin, insertion, action and nerve supply of 



20 ANATOMY. 

any one of the following muscles: superior oblique, mas= 
seter, trapezius. 

Trapezius, origin from external occipital protuberance, 
inner third of superior curved line of occipital bone, liga- 
mentum nuehae, spine of seventh, cervical vertebra, spines of 
all thoracic vertebrae; insertion into posterior border, outer 
third of clavicle, inner margin of acromion and entire upper 
border of spine of scapula ; action, to retract head, to approxi- 
mate scapulae, to elevate point of shoulder, to assist serratus 
magnus in rotating scapula, as in act of carrying arm to up-' 
right vertical position; nerves, spinal accessory, third and 
fourth cervical. 

Give the origin, main branches and relations of any 
one of the following arteries: external carotid, axillary, 
femoral. 

Axillary artery is continuation of subclavian from outer 
border of 1st rib, extends to lower border of axilla (teres 
major muscle) in line indicated by coraco-brachialis muscle 
(inner border), lying behind and above axillary vein; outer 
cord of brachial plexus is above it, inner cord is below it, 
posterior cord is behind it, median nerve lies upon it; pecto- 
ralis minor muscle crosses it in front, pectoralis major is ante- 
rior to first -and third portions; branches are superior tho- 
racic, acromial thoracic, long thoracic, alar thoracic, sub- 
scapular, anterior and posterior circumflex. 

Describe the course of the nerve fibres in the optic 
commissure. 

Fibres upon its posterior surface (G-udden's commissure) 
have nothing to do with sight, and unite posterior quadri- 
geminal bodies (testes) ; middle fibres decussate, those from 
right optic tract passing to left optic nerve and vice versa, 
to terminate in nasal half of retina ; outermost fibres of each 
tract do not decussate, but pass into optic nerve to be dis- 
tributed to temporal half of retina of same side. 



ANATOMY. 21 

Give the origin, course and distribution of the great 
sciatic nerve. 

Origin from lower lumbar and upper sacral nerves (sacral 
plexus; course, through great sacro-seiatie foramen below 
pyriformis muscle, from beneath lower margin of gluteus 
maximus midway between trochanter major and tuber ischii, 
rests upon adductor magnus and divides about middle of thigh 
into internal and external popliteal nerves; it supplies semi- 
tendinosus, semimembranosus, adductor magnus and biceps. 
Internal popliteal is continued down leg as posterior tibial, 
distributed to back of leg and sole of foot ; external popliteal 
curves around below head of fibula to front of leg, becoming 
anterior tibial to front of leg and dorsum of foot. 

Describe the great omentum. 

Made up of double fold of peritoneum, extending from 
greater curvature of stomach downward for variable distance, 
then returning, surrounds transverse colon. It contains be- 
tween its layers more or less adipose tissue. 

Give the gross and the topographic anatomy of the 
pancreas. 

The " abdominal salivary gland " is located in upper pos- 
terior part of abdomen, behind stomach, in front of vertebral 
column and left kidney, and to right of spleen. Is elongated, 
soft in consistency, made up of lobules held together by con- 
nective tissue, is pinkish in color, and is divided into tail, 
body and head, the latter embraced by curve of duodenum. 
Is supplied by branches from splenic artery, which courses 
along upper border. Its duct, extending throughout the 
length of the gland, terminates with common bile duct in 
descending portion of duodenum. 

Locate and describe the pericardium. 

Fibro-serous sac surrounding heart, pyramidal, with base 
attached to central tendon of diaphragm, apex corresponding 
to great vessels at base of heart, and connected with deep 



22 ANATOMY. 

cervical fascia by fibrous prolongations upward. Outer layer 
fibrous, lined with parietal serous layer, which is reflected 
upon heart and vessels at its base, constituting the visceral 
layer. 

Describe and give the anatomical relation of the ap= 
pendix vermiformis. 

Is 31/2 to 4% inches long, made up of inner mucous coat, 
which is thickly set with simple, tubular glands (crypts of 
Lieberkuhn) and covered with columnar epithelium, beneath 
which is a thick layer of adenoid tissue, diffused and collected 
into closed follicles; outside of mucous membrane is sub- 
mucosa, with plexuses of vessels and nerves; next comes 
muscular layer, having thick, inner circular and thinner, 
outer longitudinal layer; the peritoneum surrounds the ap- 
pendix and forms a meso-appendix, usually extending along 
one-half the length of the organ; in this the appendicular 
artery (branch of ileo-colic) courses; arterial supply is of the 
end-artery variety; the nerves are branches of the superior 
mesenteric plexus of the sympathetic system. The appendix 
is attached to the cecum, usually depending from its inner 
and posterior aspect, not far from ileo-cecal junction; it may 
extend in any direction. In the female a fold of peritoneum 
is continued from the broad ligament to the meso-appendix 
(appendiculo-ovarian ligament) , and conveys a branch of the 
ovarian artery. 

Describe Poupart's ligament, naming its anatomical re= 
lations and uses as a surgical guide. 

Is formed by aponeurosis of external oblique muscle blend- 
ing with fascia lata, and extends, slightly curved downward, 
from anterior superior iliac spine to pubic spine ; a reflected 
portion, Gimbernat's ligament, is attached to pubic end of 
iliopectineal line, forming inner margin of femoral (crural) 
ring (neck of femoral hernia). Beneath Poupart's ligament 
external cutaneous nerve, ilio-psoas muscle, anterior crural 
nerve, femoral artery and vein are located; above and to 



ANATOMY. 23 

outer side of pubic spine it forms outer pillar of external 
inguinal ring. 

Describe the femoral artery and its branches. 

Begins as continuation of external iliac beneath middle of 
Poupart's ligament, extends downward, bisecting Scarpa's 
triangle, through Hunter's canal, at lower end of which it 
becomes the popliteal. Branches are superficial epigastric, 
superficial circumflex iliac, superficial and deep external 
pudic, profunda, anastomotica magna, muscular. 

Name the principal lobes of the brain and the fissures 
dividing them. 

Frontal, parietal, temporal, occipital, central (island of 
Reil) . Fissure of Rolando separates frontal from parietal ; 
fissure of Silvius separates frontal and parietal from tem- 
poral; parietooccipital fissure separates parietal from occip- 
ital ; central lobe is found deeply placed in Sylvian fissure. 

Name the twelve pairs of cranial nerves. 

Olfactory, optic, motor oculi, trochlear, trigeminal, abdu- 
cens, facial, auditory, giosso-pharyngeal, pneumogastric, spi- 
nal accessory, hypoglossal. 

Name the bones articulating with the humerus. 

Scapula, radius, ulna. 
Describe the Eustachian tubes. 

Two tubes connecting middle-ear with naso-pharynx. 
Pharyngeal orifice is usually vertical slit just above floor of 
nasal chamber, behind posterior naris, and bounded poste- 
riorly by " cushion " of pharynx. Tube is formed by tem- 
poral bone in angle between squamous and petrous portions, 
and by coiled plate of cartilage attached to edge of bony part 
of tube ; is lined with ciliated columnar epithelium. 

Describe the diaphragm, its principal openings and 
nerve supply. 

Dome-shaped muscle, origin from inner surface of last six 



24 ANATOMY. 

costal cartilages, posterior surface of ensiform cartilage, by 
two crura from bodies of lumbar vertebrae (2d to 4th), from 
ligamenta arcuata, external and internal. Insertion into 
aponeurotic central tendon, which consists of three leaflets. 
Aortic opening is between crura, and transmits aorta, thoracic 
duct and vena azygos major; esophageal opening is anterior 
and slightly to left of vertebral column, transmitting eso- 
phagus and both pneumogastric nerves; caval opening is in 
right leaflet of central tendon, and to its margins the outer 
coat of inferior cava is attached. Nerve supply, both 
phrenics. • 

Describe the broad ligaments of the uterus and their 
anatomical relations. 

Double folds of peritoneum attached to floor and lateral 
margins of true pelvis, covering uterus anteriorly and pos- 
teriorly, reflected from it to bladder in front and to vagina 
behind. Between its layers are found Fallopian tubes, round 
ligaments, utero-ovarian ligaments, uterine and ovarian 
arteries and veins, lymphatics, 'and fetal relics. The ovaries 
are attached to it behind, near the pelvic brim. 

Describe the crystalline lens, and state what tissues are 
in contact with it, and how. 

Is a transparent, biconvex body, convexity being greater 
upon posterior surface than upon anterior; is contained in 
capsule, which is elastic; it consists of lens-fibres, which are 
derived from epithelial cells (ectoderm), arranged in layers, 
which are of softer consistency near the surface (cortex), 
more compact and dense at the center (nucleus). It is non- 
vascular in the adult, its nutrition being maintained by inter- 
cellular transmission of nutritive fluids. Its suspensory lig- 
ament is formed by hyaloid membrane enclosing the vitreous, 
and is attached to lens capsule. The lens rests in patellar 
fossa of vitreous, iris (pupillary margin) rests upon its ante- 
rior surface, and ciliary processes are in relation with its 
circular edge. 



ANATOMY. 25 

Give a brief description of the membranes of the brain. 

The dura lines the cranial cavity, is adherent to the vault, 
sides and base, and sends processes between cerebral hemis- 
pheres (falx cerebri), between cerebrum and cerebellum 
(tentorium cerebelli), and between hemisphere of cerebellum 
(falx cerebelli) ; it splits to form spaces for the intima of 
veins, known as venous sinuses. The arachnoid, between dura 
and pia, is thin and delicate, and contains spaces for cerebro- 
spinal fluid, best developed 'at base of brain. The pia closely 
invests the encephalon, dipping into fissures and sulci, send- 
ing arterial branches into cerebral substance and receiving 
veins from same, and passes through transverse fissure into in- 
terior of brain, constituting velum interpositum, and furnish- 
ing choroid plexuses of ventricles. 

Describe the gross anatomy of the larynx. 

Consists of cartilaginous framework, ligaments, muscles, 
and is lined w T ith mucous membrane. Cartilages are thyroid, 
cricoid, two arytenoids, two cornicula laryngis and epiglottis. 
Thyroid is shield-shaped, projects forward as pomum Adami ; 
cricoid is ring-shaped, is placed below thyroid, is broad pos- 
teriorly and supports arytenoids, one on each side of posterior 
quadrilateral portion. Epiglottis is attached by stem to angle 
of thyroid, and is directed upward over entrance to larynx. 
Crico-thyroid membrane extends from cricoid cartilage up- 
ward within thyroid, and by rounded, free edge forms true 
vocal bands, which extend between thyroid anteriorly and 
vocal processes of arytenoids posteriorly. Lateral crico- 
arytenoid muscles approximate vocal bands, posterior crico- 
arytenoid muscles separate them. Superior laryngeal artery 
pierces thyro-hyoid membrane to supply interior of larynx, 
superior laryngeal nerve is nerve of sensation to mucous 
membrane, and recurrent laryngeal is motor nerve to all mus- 
cles but one (crico-thyroid) supplied by superior laryngeal. 

Minutely describe the relations of the peritoneum to 
the bladder. 

Covers upper surface and sides, reflected on to rectum in 



26 ANATOMY. 

male and vagina in female; leaves anterior abdominal wall 
just above symphysis to form loose fold between bladder and 
symphysis, then passing to summit of bladder without cover- 
ing its anterior wall, thus forming prevesical space (space of 
Retzius) . 

Describe the endocardium. 

Is continuous with the tunica intima of the vessels at the 
base of the heart, lines both auricles and both ventricles, and 
forms, strengthened by fibrous tissue, the several valves of 
the heart. 

What parts of the brain does the Pons Varolii connect? 

Cerebellum with posterior quadrigeminal bodies (testes), 
one cerebellar hemisphere with the other, parts below (cord 
and medulla) with cerebral hemisphere above. 

Name the ganglia connected with the 5th pair of cranial 
nerves. 

Gasserian, ophthalmic, spheno-palatine (Meckel's), otic, 
submaxillary. 

Give an anatomical description of the bronchial tubes. 

Formed by division of trachea ; right and left bronchial 
tubes pass into right and left lungs respectively at root of 
lung, dividing and subdividing, finally becoming, bronchioles. 
Each consists of rings or plates of cartilage held together by 
an elastic membrane, and are lined by mucous membrane 
possessing ciliated columnar epithelial cells in larger tubes 
and squamous cells in smallest tubes. 

Name the branches of the subclavian artery. 

Vertebral, internal mammary, thyroid axis (inferior thy- 
roid, transverse cervical, suprascapular), superior intercostal. 

Describe the inguinal canal. 

Is a flat-sided passage in the lower part of the inguinal 
region, extending between internal and external abdominal 
rings; its " floor " is formed by transversalis fascia meeting 



ANATOMY. . 27 

Poupart's ligament; its "roof" toy conjoined tendon (internal 
oblique and transversalis muscles) ; interior wall by skin, 
superficial fascia, aponeurosis of external oblique, internal 
oblique ; posterior wall by transversalis fascia, pre-peritoneal 
fat and peritoneum. Is about l 1 /? inches long in adult, trans- 
mitting spermatic cord in male and round ligament in female. 

If the femoral artery were obstructed at the apex of 
Scarpa's triangle, through what channels would the blood 
flow to reach the tibial artery? 

Through profunda femoiis and its branches, anastomosing 
with articular branches of popliteal. 

Name the structures that maintain the bladder in posi= 
tion, male and female. 

Recto- vesical fascia, folds of peritoneum, in both sexes; 
rectum in male, uterus and vagina in female. 

Where are the ventricles of the larynx? 

Between the true and false vocal cords. 

Describe the triangle of the elbow and name the struc= 
tures that pass through it. 

Base directed upward, formed by line drawn between the 
two condyles, outer side bounded by supinator longus, inner 
side by pronator radii teres; floor is formed by brachialis 
anticus and supinator brevis. It contains brachial artery 
and venae comites, radial and ulnar arteries, median and 
musculo-spiral nerves, and tendon of 'biceps. 

Name the abdominal viscera partially covered by peri = 
toneum. 

Right and left suprarenal bodies, right and left kidneys, 
pancreas, duodenum, ascending and descending colons, rec- 
tum, bladder, uterus. 

Describe the arteries and veins passing to and from the 
kidneys. 

Renal artery, branch of abdominal aorta, enters hilum. 



28 ANATOMY. 

breaks up into branches which pass between Malpighian pyra- 
mids to 'CorticO-medullary junction, then sending branches 
into cortex and medulla. Veins are similarly arranged, be- 
ginning in interior of kidney ; they leave by passing through 
sinus and hilum, known as renal vein, to join inferior cava. 

Give the anatomy of the bladder, including blood and 
nerve supply. 

A reservoir in the pelvis, partially covered by peritoneum, 
consisting of involuntary muscular fibres extending in longi- 
tudinal and circular directions, a submucosa and a mucous 
membrane,' the latter possessing transitional, squamous epithe- 
lial cells. Blood supply is from internal iliac artery, through 
superior, middle and inferior vesical branches; nerve supply 
is from pelvic plexus of sympathetic and from 3d to 4th 
sacral nerves. 

Describe the testes. 

They are two seminal glands contained within the scrotal 
cavity, suspended by the spermatic cord, and surrounded by 
a peritoneal process, the tunica vaginalis testis. Each gland 
consists of a fibrous stroma, the tunica albuginea, dividing 
the interior into compartments which contain the seminiferous 
tubules, the latter converging toward the posterior part of 
the gland, and emerging to constitute the epididymis. 

Describe the structure of the prostate gland and give 
its anatomical relations. 

It possesses a, capsule of fibrous tissue, enclosing voluntary 
and involuntary muscle and branched tubular glands opening 
into prostatic urethra; base is closely applied to "neck" of 
bladder, circular muscular fibres of which are continued 
around prostatic urethra, which pierces prostate from base 
to apex ; behind is rectum ; in front is pubo-prostatic plexus 
of veins separating it from symphysis pubis; ejaculatory 
ducts pass through gland between middle and lateral lobes. 

With what bones does the clavicle articulate? 

Sternum, cartilage of first rib, scapula. 



ANATOMY. 29 

Give the origin and distribution of the median nerve. 

Formed by branch from outer and one from inner cord of 
brachial plexus in axillary space, over front of axillary artery, 
is in close relation to brachial artery to bend of elbow, when 
branches are distributed to all superficial muscles in front of 
forearm except flexor carpi ulnaris ; a branch known as ante- 
rior interosseous supplies outer half of flexor profundus, flexor 
longus pollicis and pronator quadratus (deep muscles) ; in 
the palm the median is distributed to integument of flexor 
surface of thumb, index, middle and middle-finger half of 
ring finger and their contiguous sides, and dorsum of distal 
segment of thumb and fingers (2%), motor branches to ab- 
ductor and opponens pollicis, superficial head of flexor brevis 
pollicis and two outer lumbricales. 

Where is the fissure of Sylvius and what artery does it 
contain? 

Begins at anterior perforated space, separates frontal and 
parietal lobes from temporal lobe, passes upward and back- 
ward to terminate in parietal lobe ; contains middle cerebral 
artery. 

Name the branches of the brachial artery. 

Superior profunda, nutrient, muscular, inferior profunda, 
anastomotica magna, radial and ulnar (terminals). 

Name the component parts of the spermatic cord. 

Spermatic artery, spermatic veins (pampiniform plexus), 
vas deferens, deferential artery and deferential veins, lym- 
phatics, nerves (spermatic plexus of sympathetic) . 

What forms the internal hamstrings? 

Tendons of semitendinosus, semimembranosus, gracilis. 

Describe the location of the intercostal arteries. 

In the intercostal groove near the lower border and inner 
surface of the rib ; anteriorly it occupies the upper part of 
the intercostal space. 



30 ANATOMY. 

What bone forms the heel and with what does it artic= 
ulate? 

Os calcis ; with astragalus and cuboid. 

What arteries supply the heart with blood, and where 
do they originate? 

Coronary (2), springing from arch of aorta just above 
sinuses of Valsalva of aortic semilunar valve. 

Name the structures located in the inguinal canal and 
give their anatomical relations. 

Spermatic cord in male, round ligament in female. Are in 
relation with walls of inguinal canal, which are, anterior, 
external oblique aponeurosis entire length, conjoined tendon 
(internal oblique, transversalis) for outer third; posterior, 
transversalis fascia and, at inner end-, insertion of conjoined 
tendon; floor is formed by Poupart's ligament and trans- 
versalis fascia ; roof by arched fibres of conjoined tendon. 

Describe the thoracic duct. 

Begins upon body of second lumbar vertebra in dilated 
pouch called receptaculum chyli, passes through aortic open- 
ing in diaphragm, then through posterior mediastinum, and 
at base of neck arches to left, terminating at junction of left 
subclavian and internal jugular veins. It drains the lymph 
from all parts of body except right upper extremity, right 
side of head and neck, right half of thorax (right lung and 
right side of heart) and upper surface of liver. 

Describe the pleura. 

A closed serous sac lining the thoracic wall (parietal layer). 
from which it is reflected to the lung, investing it (visceral 
layer), dipping into the fissures and sending process from 
root of lung to diaphragm (ligamentum latum pulmonis). 

Name the seven openings into the pharynx. 

Two posterior nares, two Eustachian orifices, mouth, larynx, 
esophagus. 



ANATOMY. 31 

Locate and describe the spleen. 

Is in the left hypochondriac region, dorsally, to left of 
fundus of stomach and to left of tail of pancreas ; is in con- 
tact with under surface of diaphragm, which separates it 
from 8th, 9th, 10th and 11th ribs. It has convex outer sur- 
face, antero-internal and postero-internal surfaces, is entirely 
covered by peritoneum, at hilum splenic artery breaks 
up into branches to enter gland (ductless) and splenic 
vein leaves interior. Anterior border is notched ; capsule 
invests it and sends trabecular into interior at hilum, 
dividing it into compartments, or areolar, which contain 
splenic pulp. Wall of arteriole becomes thickened with lym- 
phoid material, which thickenings are known as Malpighian 
corpuscles. Minute arterioles terminate abruptly in areolar, 
where blood mixes with splenic pulp. Color of spleen is 
purple. 

What bones make up the pelvis? Give the gross anat= 
omy of the bony pelvis. 

Two ossa innominata (ilium, ischium, os pubis), sacrum and 
coccyx. Bony pelvis consists of upper expanded portion 
called the false pelvis, and lower slightly cordiform cavity 
known as the true pelvis. The true pelvis has inlet, cavity 
and outlet, conjugate (antero-posterior), transverse and ob- 
lique diameters. 

Mention the muscular and the ligamentous attachments 
of the patella. 

Quadriceps extensor femoris (rectus, vastus interims and 
externus, crureus) ; ligamentum patellar. 

Describe the wrist=joint. 

Is formed by radius and triangular cartilage above, sca- 
phoid, semilunar and cuneiform below. (Ulna is separated 
from cuneiform by triangular interarticular cartilage, hence 
is excluded from wrisit- joint). Ligaments are anterior and 
posterior, external and internal lateral. Movements are 
flexion, extension, abduction, adduction, circumduction. 



32 ANATOMY. 

What muscles assist in mastication? In deglutition? 

(a) Temporal, internal and external pterygoids, masseter. 
(b) Mylohyoid, digastric, stylo-hyoid (first part of act) ; 
omo-hyoid, sterno-hyoid, sterno- thyroid, thyro-hyoid (second 
part of act). 

State (a) the nerve supply of the rectum, (b) the blood 
supply of the rectum. 

(a) Sympathetic branches from inferior mesenteric and 
hypogastric; plexuses inferior hemorrhoidal, branch of in- 
ternal pudic. (lb) Superior and middle hemorrhoidal arter- 
ies, branches of inferior mesenteric and anterior trunk 
of internal iliac respectively; inferior hemorrhoidal, branch 
of internal pudic. 

Describe the internal jugular vein. 

Is formed just below jugular foramen by lateral and infe- 
rior petrosal sinuses ; courses down neck beneath anterior 
border of sterno-eleido-mastoid muscle, in a common sheath 
with the internal carotid (above), common carotid (below), 
and pneumogastric nerve, the latter behind and between, and 
the artery to the inner side of the vein, which partially over- 
laps the artery. Behind sternal end of clavicle it unites with 
subclavian to form innominate vein. 

With what bones does the radius articulate? 

Humerus, ulna, scaphoid and semilunar. 
Name the branches of the abdominal aorta. 

Two phrenics, celiac axis (brs. gastric, hepatic, splenic), 
superior and inferior mesenteric, suprarenals, renals, lumbar 
arteries (4), spermatic or ovarian, middle sacral and right 
and left common iliacs. 

What are the anterior and posterior boundaries of the 
axilla, and what arteries and nerves pass through it? 

Anterior boundary: Pectoralis major and minor. Poste- 
rior boundary: Subscapulars, teres major and latissimus 



ANATOMY. 33 

dorsi. Arteries passing through: Axillary and its branches 
(superior thoracic, acromial thoracic, long thoracic, alar tho- 
racic, subscapular, anterior and posterior circumflex). 
Nerves passing through : Brachial plexus, consisting of outer, 
middle and inner cords, with branches as follows: Musculo- 
cutaneous, internal and lesser internal cutaneous, circumflex, 
ulnar, musculo-spiral, median. 

Give the origin and distribution of the third division 
of the fifth pair of nerves. 

Origin : From Gasserian ganglion at apex of petrous bone, 
passes through foramen ovale with motor root, with which it 
now unites; divided into anterior and posterior divisions, 
anterior being mostly motor to muscles of mastication (tem- 
poral, pterygoids, masseter), posterior division forming infe- 
rior dental, which furnishes mylo-hyoid to muscle of same 
name, branches to teeth, incisor and mental branches; auri- 
culo-temporal, sensory to ear and temple; lingual, which re- 
ceives chorda tympani branch of facial and is distributed to 
tongue. 

Bound Scarpa's triangle, and mention the vessels and 
nerve in it. 

Is bounded by Poupart's ligament above, sartorius exter- 
nally, adductor longus internally; vessels are common and 
superficial femoral, profunda f emoris arteries ; femoral vein ; 
nerve is anterior crural. 

Give the location and describe the anatomical struc= 
ture of the kidneys. 

Are placed in loins, resting upon psoas magnus and quad- 
ratus lumborum muscles, upper end of left reaching as high 
as upper border of 11th rib, upper end of right as high as 
lower border of 11th rib. Each is capped by suprarenal body, 
is surrounded by capsule and perirenal connective tissue con- 
taining fat, is supplied by renal artery, and drained by renal 
vein and lymphatics; nerves from renal plexus of sympa- 
3 



34 ANATOMY. 

thetic system. The kidney is bean-shaped, notch upon inner 
border is called the hilum, leading into a depression or 
cavity known as the sinus; here the renal duct, or ureter, 
begins and the vessels and nerves enter or leave. The interior 
of the gland consists of a connective tissue parenchyma sup- 
porting vessels and uriniferous tubules, arranged as cortex 
and medulla; the cortex contains the glomeruli (coiled-up 
blood vessels — "little ball of yarn") and some of the tubules; 
the medulla consists of pyramids (MJalpighian or medullary) 
made of parallel collecting tubules, which terminate upon 
the apex of the pyramid, pouring urine into the calices of the 
"pelvis of the kidney," the upper expanded portion of the 
ureter. The uriniferous tubules begin around a glomerulus 
as a closed extremity (capsule of Bowman), then pass tor- 
tuously through the cortex down into the medulla and back 
again into the cortex (loop of Henle), terminating in one of 
the collecting tubules found in the pyramid of Ferrein, whose 
base is in apposition with the base of a medullary pyramid. 

Describe the mesentery. 

Is a double fold of peritoneum attached to posterior ab- 
dominal wall in an oblique line extending between the left 
side of the body of the second lumbar vertebra to the right 
sacro-iliac joint, a distance of about eight inches. Between 
its two layers are found arteries, veins, lymphatics (lacteals), 
lymphatic nodes (mesenteric "glands"), and more or less 
fat; to its expanded, convoluted edge the small intestine is 
attached, the mesenteric layers surrounding it and constitut- 
ing its serous covering. 

Give the name and location of the various glands found 
in the small intestine. 

Glands in small intestine: Duodenal ("Bruner's"), in 
duodenum; intestinal follicles ("crypts of Lieberkuhn"), in 
whole length of small and large intestine ; solitary glands, in 
wall of small intestine, collected into colonies in ileum, then 
known as Peyer's patches. 



ANATOMY. 35 

Give a brief yet comprehensive description of the heart. 

Base corresponds to upper level of third costal cartilage, 
one inch to right of sternal margin and one-half inch to left ; 
apex to fifth intercostal space just internal to vertical line 
drawn through left nipple ; base is directed upward and back- 
ward to the right, apex downward, forward and to the left. 
Is surrounded by fibro-serous sac called pericardium, consist- 
ing of two layers, fibrous externally, serous internally, the 
latter lining sac (parietal layer) and covering heart (visceral 
layer), it is attached to iceritral tendon of diaphragm. 
Right auricle has openings of superior and inferior venae 
cava? and coronary sinus; right ventricle receives blood from 
right auricle through right auriculo-ventricular opening 
(tricuspid valve), and expels it through conus arteriosus into 
pulmonary artery, Which is guarded by pulmonary semilunar 
valve; right ventricle contains columnae earneae, musculi 
papillares, chordae tendineae attached to tricuspid valve seg- 
ments; left auricle has four openings for pulmonary veins 
and left auriculo-ventricular opening, guarded by mitral 
valve; left ventricle has columnae earneae, etc., like right, 
its wall is thicker ; it forms apex of heart, and blood leaves it 
by passing into aorta, which is guarded by aortic semilunar 
valve; coronary arteries (2), branches of aorta above semi- 
lunar valve, supply heart muscle. Heart is lined with endo- 
cardium. Pneumogastrics and cardiac plexuses of sympa- 
thetic nervous system supply heart. 

What forms the external malleolus? 

Lower end of fibula. 

Describe one of the vertebrae. 

Consists of centrum, or body, projecting anteriorly, with 
arch behind, made up of two (lateral) pedicles, converging 
laminae to form spinous process, transverse process on each 
side, superior and inferior pair of articular processes, inter- 
vertebral notch on under side of each pedicle. 



36 ANATOMY. 

Describe the position of the palmar arterial arches. 

Superficial palmar arch, is placed upon tendons of flexor 
sublimis digitorum, extending across palm at level of line 
drawn transversely at angle of web between thumb and index 
finger; deep arch lies upon metacarpal bones and interossei 
muscles, one-half inch nearer carpus than superficial arch. 

What blood vessels pass to and from the liver? 

To it, hepatic artery, portal vein ; umbilical vein in foetus ; 
from it, hepatic veins. 

Describe the pyloric orifice of the stomach. 

Is directed backward and to right, is near neck of gall- 
bladder, consists of special thickening o>f stomach wall pro- 
duced by circular muscular fibres, which have sphincter-like 
action. 

What tissues of the abdominal wall are divided in the 
operation for appendicitis? 

Skin, superficial fascia, external oblique muscle, internal 
oblique and transversalis muscles, transversalis fascia (pre- 
peritoneal fat) , peritoneum. Or, skin, superficial fascia, linea 
semilunaris, transversalis fascia, peritoneum. 

With what bones does the frontal articulate? 

Both parietal, both malar, both nasal, both lachrymal, both 
maxillae (superior), ethmoid, sphenoid. 

Give the course and relations of Stenson's duct. 

Is formed in parotid gland, emerges from its anterior bor- 
der, resting upon masseter muscle a finger's breadth below 
zygoma; it then perforates buccinator muscle, runs forward 
and pierces mucous membrane of cheek wall opposite upper 
middle molar tooth. 

Describe the Fallopian tubes and give their relations. 

Oviducts are attached to cornua of uterus, extend laterally 
to a point near pelvic brim, here expanding into fimbriated 
extremity; one of the fimbriae is attached to ovary (tubo- 






ANATOMY. 37 

ovarian ligament). Each tube is lined with mucous mem- 
brane thrown into folds, possessing columnar, ciliated epithe- 
lium, outside of which is muscular coat of internal circular 
and external longitudinal fibres, the whole being covered 
by peritoneum of broad ligament. Ovarian and uterine 
arteries anastomose along their lower border; fimbriated ex- 
tremity is dn close relation to ovary; outer part of broad 
ligament, extending from tube to pelvic wall, is called infun- 
dibulo-pelvic ligament, and contains ovarian artery and veins. 

Describe the dura mater. Mention the processes and 
sinuses of the dura mater. 

Forms the lining or endosteum of cranial cavity, and 
extends through foramen magnum into neural canal as ex- 
ternal layer of theca of cord; is tough and fibrous, forms 
projections or shelves in cranial cavity for support of 
encephalon. These are falx cerebri, falx cerebelli, tentorium 
cerebelli. Dura consists of two layers, endosteal and menin- 
geal, which separate at certain places to permit the entrance 
of the tunica intima of a vein, thus forming venous sinuses 
of cranium. These are superior and inferior longitudinal, 
straight, two lateral, occipital, two superior and inferior 
petrosal, transverse, circular, and two cavernous. 

Give the macroscopic and the microscopic appearance of 
(a) kidney tissue, (b) lung tissue, (c) nerve fiber. 

(a) Kidney tissue is moderately firm, somewhat granular, 
reddish-brown in color. Microscopically it presents glomer- 
uli, uriniferous tubules, blood vessels and interstitial con- 
nective tissue, (b) Lung tissue is of a mottled pink color, 
soft and porous. Under the microscope it shows bronchioles 
(fibrous wall of elastic tissue lined with mucous membrane) 
and alveoli, dilatations lined with mucous membrane of squa- 
mous epithelial cells, outside of which are seen capillary blood 
vessels, (c) Nerve fibre is cord-like, soft and white. Histo- 
logically it consists of axis cylinder surrounded by white 
substance of Schwann (medullary substance) (absent in non- 



38 ANATOMY. 

medullated nerves) and encased in the neurilemma. Inter- 
ruptions in the medullary suibstance occur (nodes of Ranvier) . 

What anatomic parts are normally found in the left 
hypochondriac region? 

Fundus of stomach, spleen and tail of pancreas, splenic 
flexure of colon, part of left kidney. 

Give in language or by drawing, the normal curvatures 
of the spinal columns, and describe a typical cervical ver= 
tebra. 

Curves are cervical, thoracic, lumbar, sacro-coccygeal ; 
convexity is forward in cervical, backward in thoracic, 
forward in lumbar, backward in sacro-coccygeal. The line 
of gravity of the trunk passes through the chords of 
these curves. A typical cervical vertebra consists of a small 
body, diverging pedicles, a bifid spinous process, bifid trans- 
verse process grooved on upper border, with a costo-trans- 
verse foramen for vertebral artery art base of transverse 
process ; neural foramen is relatively large. 

Name the bones and ligaments of the ankle=joint. 

Tibia, fibula, astragalus; anterior and posterior, internal 
(deltoid) and external lateral ligaments. 

Name the principal muscles that keep the body erect 
on the thigh and give the origin and insertion of any one 
of them. 

Gluteus maximus, gluteus medius, gluteus minimus, ham- 
strings ; gluteus maximus takes its origin from outer surface 
of ilium between posterior part of crest and superior gluteal 
line, from vertebral aponeurosis, two last pieces of sacrum, 
posterior surface of great sacro-sciatic ligament, and is in- t 
serted into gluteal ridge of femur 'and ilio-tibial band of 
fascia lata. 

Give the origin, distribution and branches of the middle 
meningeal artery. 

Is branch of internal maxillary, passes through foramen 






ANATOMY. 39 

spinosum of sphenoid, traverses Avail of middle cranial fossa, 
dividing into anterior and posterior branches (meningeal) 
supplying dura and bony wall of cranium. 

Where does the g!osso=pharyngeal nerve rise and what 
structures are supplied by this nerve and its branches? 

Arises from, groove between olivary and restiform bodies, 
passes out of cranial cavity through jugular foramen, divides 
into lingual and pharyngeal branches, supplying mucous 
membrane of posterior part of tongue ( circumvallate papillae) 
and mucous membrane of pharynx. A branch (Jacobson's) 
is distributed to tympanum. 

Describe the pharynx. 

Belongs to both respiratory and alimentary tracts, is lined 
with mucous membrane possessing ciliated columnar cells 
above, and squamous, stratified cells below level of soft palate ; 
pharyngeal aponeurosis is between mucous membrane and 
constrictor muscles ; constrictor muscles are three in number, 
superior, middle, inferior. Pharynx is flattened antero-pos- 
teriorly, is widest opposite greater cornua of hyoid bone, and 
communicates with posterior nares. with middle ears by 
Eustachian tubes, with mouth, larynx and esophagus. The 
pharyngeal tonsil is located upon upper posterior wall, and 
consists of a special collection of adenoid tissue, which is 
found more or less freely distributed throughout naso- 
pharynx. 

Name the regions of the abdomen. 

Draw transverse line through anterior superior iliac spines ; 
also through costal cartilages of 10th ribs; intersect with 
vertical lines through center of Poupart's ligament. Nine 
regions thus formed are, from above downward, right and 
left hypochondriac, epigastric, right and left lumbar, umbil- 
ical, right and left inguinal, hypogastric. 

Locate and describe the cecum. 

First part of large intestine, found below ileo-cecal June- 



40 ANATOMY. 

tion in right iliac fossa ; is entirely surrounded by peritoneum, 
possesses sacculations, that upon right side usually larger, 
thus throwing original ((fetal) apex to left, at which point 
appendix vermiformis' is attached. Longitudinal muscular 
bands well denned. 

Describe the eyeball and give its parts. 

Is spherical in shape, embedded in orbital fat, has ocular 
muscles attached to it, is perforated by optic nerve and ciliary 
arteries and veins, (posterior five-sixths opaque, anterior one- 
sixth transparent. Its walls are made up of sclerotic and 
cornea, uveal tract (choroid) and retina, enclosing crystalline 
lens and vitreous body. Behind cornea is anterior chamber 
containing aqueous humor; in front of crystalline lens is iris. 

Give the names of five muscles of the male perineum. 

Ischio-cavernosus, compressor urethral, bulbo-cavernosus, 
transversus perinei, sphincter ani externus. 

Name five muscles of the back of the leg. 

Gastrocnemius, plantaris, soleus, tibialis posticus, flexor 
longus digitorum. 

Name the principal divisions and subdivisions of the 
internal carotid artery. 

It divides, after passing through cavernous sinus, into ante- 
rior and middle cerebral arteries; its subdivisions are oph- 
thalmic -and posterior communicating. 

Locate and describe the i!eo=cecal valve. 

Is found at junction of ileum with cecum, formed by 
ileum passing upward and outward to the right to meet large 
bowel obliquely; its orifice is a horizontal slit projecting into 
cecal lumen. 

Describe either the ascending or descending vena cava. 

Ascending vena cava is formed by union of the two common 
iliac veins upon body of fifth lumbar vertebra, passes upward, 
resting on bodies of vertebra to right of aorta, pierces dia- 



ANATOMY. 41 

phragm at eaval opening, and almost immediately enters right 
auricle. Its tributaries are lumbar veins, right spermatic 
vein (or ovarian), renal veins, hepatic veins, phrenic veins. 

Name the bones that form the ank!e=joint and give their 
relations. 

Tibia and fibula above, with internal and external malleoli, 
respectively, forming mortise for astragalus, whose trochlear 
surface and sides fill up the space between the two bones of 
the leg. 

What muscles form the quadriceps extensor crureus and 
where is its conjoined tendon inserted? 

Rectus femoris, vastus externus, vastus internus, crureus; 
tendon is inserted into tubercle of tibia. 

With what bones does the malar articulate? 

Frontal, superior maxilla, temporal, sphenoid. 

What arteries supply the bladder in the male, and from 
what are they branches? 

Superior, middle and inferior vesicle, branches of anterior 
trunk of internal iliac. 

In an amputation of the forearm, 3 inches above the 
wrist, what arteries will it be necessary to tie, and of 
what are they branches? 

Radial and ulnar arteries, branches of 'the brachial ; interior 
and posterior interosseous arteries, branches of the ulnar. 

Locate the 4th ventricle of the brain. 

Floor is formed by medulla and pons, borders by inferior 
and superior peduncles of cereibellum, with middle peduncles 
at lateral angles ; roof is formed by valve of Vieussens, or 
superior medullary velum, above, inferior medullary velum 
and tela choroidea inferior below. 

Locate and briefly describe the gall=bladder. 

Is placed upon under surface of right lobe of liver, in so- 



42 ANATOMY. 

called fissure for gall-bladder; fundus projects beyond ante- 
rior border of liver. Is a pear-shaped sac covered by perito- 
neum, having a rounded end called the fundus, and a 
constricted posterior extremity known as the neck, which is 
continued into the cystic duct. Its wall is composed of 
fibrous and muscular tissue, and it is lined with mucous 
membrane, which is thrown into 'corkscrew-like folds at the 
neck and beginning of the cystic duct. 

Describe the esophagus as to (a) location, (b) dimen= 
sions, (c) arterial supply. 

Is located behind trachea, and in posterior mediastinum, 
extending from lower end of pharynx to cardiac end of stom- 
ach at esophageal orifice of diaphragm. It is 10 inches long; 
its arterial supply is by branches from the inferior thyroid 
(thyroid axis of subclavian), thoracic aorta, gastric (coeliac 
axis), left phrenic. 

Describe the rectum as to structure, length and con= 
tained glands. 

Extends from third piece of sacrum to anus, curved for- 
ward. FTom third piece of sacrum to tip of coccyx is par- 
tially covered by peritoneum. Its walls consist of peritoneum 
or fibrous tissue externally, within which is muscular coat of 
longitudinal and circular fibres; then comes submucosa sup- 
porting mucous membrane, the latter forming fixed, trans- 
verse folds (plicae recti, or valves of Houston), two or three 
in number, extending transversely around portion of rectum. 
Glands are of mucous variety. 

How is the eye supplied with blood? 

By the ophthalmic artery, forming ciliary branches and 
. arteria centralis retinae. 

What is the circle of Willis? 

An arterial anastomosis at base of brain, formed by internal 
carotid arteries as follows: Each internal carotid sends for- 
ward the anterior cerebral, which is connected with the oppo- 



ANATOMY. 43 

site anterior cerebral 'by the anterior communicating; it 
furthermore sends backward the posterior communicating 
which meets the posterior cerebral, which is a branch of the 
basilar. 

Name and bound the ventricles of the brain. 

The lateral ventricles (first and second) are bounded above 
by corpus callosum; below toy intraventricular portion of 
corpus striatum, taenia semicircularis, choroid plexus, optic 
thalamus, posterior pillar of fornix, corpus fimbriatum; in- 
ternally by septum lucidum. Third is bounded above by 
velum interpositum ; below by gray matter at base of brain. 
i. e., lamina cinexea, tuber cinereum, corpora albicantia, pos- 
terior perforated space and tegmenta of crura cerebri ; later- 
ally by optic thalami ; anteriorly by lamina cinerea and 
anterior pillars of fornix; posteriorly by posterior commis- 
sure and pineal gland (epiphysis cerebri). Fourth ventricle 
is bounded above 'by valve of Vieussens (superior medullary 
velum), in the middle !by epithelial lining and pia; below 
by inferior medullary velum; floor is formed above by pons, 
below by medulla ; sides are formed by superior, middle and 
inferior cerebellar peduncles. 

Describe the sympathetic nerve, naming and locating 
the principal ganglia. 

Consists of a double chain of ganglia extending along 
either side of vertebral column anteriorly, connected by 
branches with each other and with spinal nerves (rami com- 
municantes), furnishing branches to blood vessels (vaso- 
motor nerves) and forming plexuses — three prevertebral 
plexuses and numerous secondary plexuses around arteries. 
Principal ganglia are ophthalmic, in back part of orbit; 
spheno-palatine, in spheno-maxillary fossa ; submaxillary, 
upon submaxillary gland; semilunar, upon aorta around 
coeliac axis. 

Give the origin, insertion and action of any one of the 



U ANATOMY. 

following muscles: occipito=frontalis, deltoid, gastrocne= 
mius. 

Deltoid arises from outer third anterior border of clavicle, 
outer margin of acromion, lower border of spine of scapula, 
entire length, and is inserted into deltoid impression upon 
outer surface of middle of shaft of humerus. Action, to 
abduct arm to horizontal position. Nerve, circumflex. 

What arteries unite to form the basilar artery? 

The two vertebrals. 

Describe the tongue. 

Consists of intrinsic and extrinsic muscles. Intrinsic are 
different divisions of lingualis (superior, inferior, transverse 
and vertical) ; extrinsic are geniohyoglossus, hyoglossus, 
styloglossus, palatoglossus. Tongue is supported by hyoid 
bone, is covered by mucous membrane thickly set with papillae, 
viz., circumvallate at base, fungiform and filiform upon dor- 
sum and margin. Nerves: Motor, hypoglossal; sensory and 
gustatory, glosso-pharyngeal, lingual, chorda tympani. 

Describe the pia mater. 

Innermost of three meninges, is closely applied to central 
nervous system, supporting blood vessels, dipping down into 
sulci and passing into general ventricular cavity of ence- 
phalon to develop choroid plexuses — vascular fringes found 
in lateral, third and fourth ventricles. 

Describe the bones of the hand with their divisions and 
articulations. 

Carpus, metacarpus, phalanges. Eight carpal bones: Sca- 
phoid, semilunar, cuneiform, pisiform, trapezium, trapezoid, 
os magnum, unciform. Five metacarpal bones; fourteen 
phalanges. Carpal articulate with each other and with bases 
of metacarpals; scaphoid and semilunar articulate with ra- 
dius ; cuneiform with triangular interarticular cartilage be- 
tween it and ulna; metacarpals articulate with each other at 
their bases and with first phalanges at their heads; phalanges 
articulate with each other and with metacarpals. 



ANATOMY. 45 

Describe the hip=joint. 

Enarthrodial, or ball-and-socket joint, formed by acetab- 
ulum and head of femur, surrounded by capsule, most im- 
portant and strongest part of which is found upon the anterior 
aspect of the joint, extending between anterior inferior spine 
of ilium and anterior intertrochanteric line (spiral line of 
femur), and is known as the "Y" ligament (ilio-femoral). 
This ligament prevents hyperextension of thigh upon pelvis, 
or falling backward of trunk. Capsule is attached to innomin- 
ate bone around margin of acetabulum and to neck of femur ; 
ligamentum teres is attached to head of femur and to bottom 
of acetabulum. Movements permitted: Flexion, extension, 
abduction, adduction, rotation and circumduction. 

Name five muscles of the shoulder and arm. Give the 
origin, insertion and action of any one of the five. 

Deltoid, coraco-brachialis, biceps, triceps, teres major. 
Biceps takes origin by two heads, one from coracoid process 
of scapula, the other from upper margin of glenoid fossa, this 
tendon passing through shoulder- joint to reach bicipital 
groove ; insertion is into deep fascia of forearm by semilunar 
(bicipital) fascia, and into bicipital tuberosity of radius; 
action is to flex forearm upon arm, 'and to supinate hand. 

Give the origin, course and branches of any one of the 
following arteries: brachial, temporal, left common carotid. 

Left common carotid arises from arch of aorta, courses 
upward and outward in line drawn from sterno-clavicular 
joint to mastoid, dividing at level of upper border of thyroid 
cartilage into its only branches, external and internal carotids. 

Describe the hemispheres and lobes of the brain. 

The cerebral hemispheres 'are ovoid, convex upon superior 
and lateral surfaces, partially separated from each other by 
longitudinal fissure, but connected by corpus callosum. 
Frontal lobe occupies anterior fossa of cranial cavity, sepa- 
rated from parietal lobe by fissure of Rolando, and from 



46 ANATOMY. 

anterior part of temporal lobe by Sylvian fissure; parietal 
lobe is bounded by fissure of Rolando anteriorly, parieto- 
occipital fissure posteriorly, Sylvian fissure inferiorly, great 
longitudinal fissure superiorly ; occipital lobe is found behind 
parieto-oecipital fissure ; temporal lobe is below fissure Sylvius, 
and rests in middle cranial fossa. 

Where in the topography of the abdomen is the sigmoid 
flexure located? The appendix vermiformis? 

(a) In left inguinal and hypogastric regions, (b) In right 
inguinal region. 

Give the surgical anatomy of femora! hernia. 

Neck of sac is at femoral, or orural, ring formed by Gim- 
bernat's ligament on inner side, femoral vein on outer, Pou- 
part's ligament in front, and horizontal ramus of pubic bone 
behind; is closed by septum crurale; crural canal is narrow 
interval between femoral vein and femoral sheath on inner 
side of vein, and extends from crural ring above to upper 
margin oi saphenous opening below. Saphenous opening is. 
closed by cribriform fascia. 

Describe the esophagus. 

Extends from lower margin of cricoid cartilage to stomach, 
is ten inches long, situated behind trachea in neck and in 
posterior mediastinum in thorax; curves forward to esopha- 
geal opening in diaphragm, through which it passes, accom- 
panied by pneumO'gastric nerves ; wall consists of external 
longitudinal and internal circular muscle fibres, a submucosa 
and a mucous membrane, which is thrown into longitudinal 
folds, and is made up of stratified epithelial cells. 

Describe the formation of the teeth. 

The teeth are composed of three substances — the enamel,, 
the dentine and the cemenftum. The enamel covers the ex- 
posed part of the tooth, the crown of the tooth. The ce- 
mentum covers the part of the tooth within the alveolus of 
the jaw. The junction of the enamel with the cementum 



ANATOMY. 47 

is 'called the neck of the tooth. The hulk of the tooth is 
made up of the dentine, which extends from the root to the 
crown. Each tooth contains a cavity, the pulp cavity, which 
communicates with the exterior through a small aperture at 
the apex of the root, the 'apical foramen. The cavity con- 
tains a soft connective tissue — the pulp, rich in vessels and 
nerves. The fang, or root, of the tooth has a fibrous invest- 
ment called the peridental membrane, or periosteum. 

Give a brief description of the facial nerve. 

The 7th cranial nerve, after passing through facial canal 
(aqueductus Fallopii) of temporal bone, emerges at the stylo- 
mastoid foramen, and enters substance of parotid gland. 
Here it divides into two sets of branches, temporo-faeial and 
cervico-faeial, supplying muscles of expression. Its chorda 
tyimpani branch traverses inner surface of membrana tym- 
pana, after leaving main trunk in facial canal, and emerg- 
ing through one end of the Gasserian fissure unites with lin- 
gual branch of 5th and accompanies it to submaxillary gland 
and ganglion and anterior % of mucous membrane of tongue. 

Describe the elbow=joint. 

Is a ginglymus, or hinge- joint, made up of lower end of 
humerus and upper ends of radius and ulna ; head of radius 
articulates with capitellum, and greater sigmoid cavity of 
ulna with trochlear surface of humerus. Its capsule is 
divided into anterior and posterior, internal and external 
lateral ligaments. It permits of flexion and extension. It 
is lubricated by synovial membrane lining its capsule. 

Describe the superior vena cava. 

Is formed by union of right and left innominate (jugulo- 
cephalic) veins, just below cartilage of 1st rib (close to right 
border of sternum) ; is nearly three inches long and terminates 
in right auricle ; it receives vena azygos major. 

Describe the temporo=maxiIIary articulation, mentioning 
the ligaments. 

Bony parts are glenoid fossa and articulating eminence of 



48 ANATOMY. 

temporal 'bone, and condyle of mandible; ligaments form a 
capsule, much stronger externally and posteriorly; external 
lateral ligament extends between tubercle of zygoma and 
neck of condyle; associated ligamentous bands are spheno- 
mandibular and stylo-mandibular ; an interarticular cartilage 
contained within the joint cavity has tendon of insertion of 
external pterygoid muscle attached to it. Movements per- 
mitted are depression and elevation of jaw around a trans- 
verse axis, and a sliding forward of both sides, protruding 
chin, or of one side at a time, producing a triturating 
movement. 

Describe the maxillary sinus (or antrum of Highmore). 

Is a triangular cavity contained in body of maxilla, lined 
with mucous membrane and communicating with middle 
meatus of nose through one or two small openings; apex of 
cavity is formed by malar iprocess of maxilla ; base is formed 
by outer wall of nose; in its posterior wall are posterior 
dental canals for posterior dental vessels and nerves to the 
teeth; in floor are usually seen several elevations, correspond- 
ing to roots of 1st and 2d molar teeth. 

Describe the aorta. 

Springs from left ventricle, anteriorly, extends upward 
to upper border of right 2d costal cartilage, then arches 
backward to left and descends through thorax, resting upon 
vertebral bodies, passes through aortic opening in diaphragm 
and courses through abdominal cavity as far as body of 4th 
lumbar vertebra. 

Branches are : Two coronary from ascending portion ; in- 
nominate, left common carotid and left subclavian from arch ; 
bronchial, intercostal, pericardiac, esophageal and posterior 
mediastinal from thoracic portion; 2 phrenic, lumbar, sacra 
media (parietal branches), celiac axis (gastric, hepatic, 
splenic), superior mesenteric, inferior mesenteric (single 
branches from front), suprarenal, renal, spermatic (or 
ovarian) (lateral paired branches) from abdominal portion. 



ANATOMY. 49 

Describe the trachea and give its anatomical relations. 

It extends from the larynx to the bronchi, and consists of 
a series of transversely directed, incomplete rings of cartilage 
united by an elastic membrane which contains involuntary 
muscle-fibre posteriorly, where the cartilaginous ring is de- 
ficient ; it is lined with a mucous membrane which is covered 
with ciliated columnar epithelial cells. 

The trachea rests upon the esophagus, being flattened pos- 
teriorly; in the groove between these two structures is the 
recurrent laryngeal nerve, upon each side ; the common caro- 
tid artery, internal jugular vein and pneumogastric nerve 
are close to it at its lower portion, while the isthmus of the 
thyroid body crosses it upon its second and third rings, and 
the lobes of the same rest upon it laterally. 

Describe the pulmonary veins. 

They are four in number, usually. 2 for each lung, and 
return arterial blood from lungs to left auricle of heart. 

Describe the spinal column. 

It consists of 33 separate vertebrae, distributed as follows : 
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal. Sacral 
and coccygeal coalesce early in life by ossification of inter- 
vertebral substances; icervical segment possesses curve with 
•convexity forward, thoracic with 'convexity backward, lum- 
bar with convexity forward, sacral with convexity backward ; 
line of gravity passes through chords of these curves. 
Special or peculiar vertebrae are : Atlas, axis, 7th cervical 
(vertebra prominens) ; ribs articulate with thoracic series; 
ilia articulate with sacrum. Spinal column 'contains neural 
canal for spinal cord. 

Give the minute anatomy of the skin. 

The skin consists of the cutis vera, formed of fibrous tissue, 
the superficial layer being raised into numerous papillae. 
This is the vascular layer of the skin. The end bulbs of the 
sensory nerves are found here also. Covering the cutis vera 
is the epidermis, formed of numerous layers of epithelium. 
4 



50 ANATOMY. 

There are four strata of the epithelium : The outer, horny, or 
stratum corneum; the stratum lucidum; the stratum granu- 
losum, and the inner or stratum mucosum. 

Give a general description of the alimentary canal, nam= 
ing its successive divisions. 

Its parts, in order, are: Mouth, pharynx, esophagus, 
stomach, small intestine (duodenum, jejuno-ileum), large in- 
testine (cecum, ascending, transverse, descending and sigmoid 
colons, rectum and anal canal) . 

Mouth is composed of upper and lower jaws covered by 
Cheek walls, with buccal orifice directed transversely; con- 
tains tongue, at 'base of which are fauces with anterior and 
posterior pillars and tonsils. 

Pharynx joins esophagus at lower border of cricoid carti- 
lage; esophagus is 10 inches long and passes through dia- 
phragm to be continued into stomach. 

Stomach occupies epigastric and left hypochondriac regions 
and presents a cardiac and a pyloric extremity and a greater 
and lesser curvature. Its wall consists of 4 co'ats, viz., serous, 
muscular, areolar and mucous. 

Duodenum is fixed and curved around head of pancreas; 
common bile and pancreatic ducts open into it ; jejuno-ileum, 
attached to posterior abdominal wall by mesentery, extends 
for 20 feet, or more, to ileo-cecal junction, where it joins large 
intestine; vermiform appendix is attached to cecum (usually 
inner side), below ileo-cecal valve; ascending colon passes to 
liver, forms hepatic flexure ; transverse colon, with great 
omentum attached, crosses to spleen and forms splenic flexure ; 
descending colon reaches! left iliac fossa and is continued into 
sigmoid which curves around into pelvis, resting on sacrum ; 
rectum curves forward and anal canal, guarded by internal 
(involuntary) and external (voluntary) sphincters, opens 
downward and slightly backward. 

State the origin and exit of the pneumogastric nerve. 

Superficial origin, from side of medulla in groove between 
olivary and restiform bodies; exit, through jugular foramen. 



ANATOMY. 51 

Describe the mastoid portion of the temporal bone. 

Mastoid bone is placed behind, is rough and convex exter- 
nally and projects downward and forward as mastoid process ; 
beneath are digastric fossa for posterior belly of digastric 
muscle, and occipital groove for occipital artery ; within sub- 
stance of mastoid are mastoid cells, the largest of which 
is called mastoid antrum, which communicates with middle 
ear; upon cerebral surface of mastoid is sigmoid groove for 
lateral sinus. 

Describe the lateral sinuses. 

Right and left lateral sinuses commence at internal occi- 
pital protuberance, right being formed by superior longitu- 
dinal sinus, left by straight sinus; are located in attached 
margin of tentorium, grooving occipital, parietal, mastoid and 
occipital bone again, leaving cranial cavity through jugular 
foramen, just outside of which they unite with inferior pe- 
trosal sinus to form internal jugular vein. 

Give the origin and insertion of the muscles which form 
the anterior triangles of the neck. 

The anterior common triangle is bounded above by the 
lower border of the mandible and a line extending backward 
from the angle of the mandible to the mastoid process of the 
temporal bone; in front, by the median line of the neck; 
behind, by the anterior border of the sterno-mastoid muscle. 
This common triangle is divided into the submaxillary, su- 
perior carotid and inferior carotid triangles, by the posterior 
belly of the digastric muscle above and the anterior belly of 
the omo-hyoid below. 

Sterno-mastoid muscle : Origin, from anterior surface of up- 
per part of manubrium sterni and inner third of anterior 
border of clavicle ; insertion, into mastoid process of temporal 
and outer half of superior curved line of occipital bone. 

Omo-hyoid muscle: Origin, from upper border of scapula 
to inner side of suprascapular notch; insertion, into body 
of hyoid bone. 



52 ANATOMY. 

Digastric muscle : Origin of posterior belly is from digastric 
fossa of mastoid portion of temporal bone, and of anterior 
belly from lower border of mandible close to symphysis; in- 
sertion, into central tendon, which is attached to body and 
greater cornu of hyoid bone. 

Name and describe the course of the arteries supplying 
the hand. 

Radial and ulnar arteries. Course of radial artery is from 
just below bend of elbow down radial border of forearm to 
outer side of wrist, where it turns over on to dorsum of hand, 
passes down through proximal end of first interosseous space 
to reach palm, now passing transversely across deep part of 
palm, to anastomose with deep communicating branch of 
ulnar artery. 

Course of ulnar artery is from near head of radius in a 
curve over to ulnar border of forearm, thence along ulnar 
border to radial side of pisiform bone, where it divides into a 
superficial branch, to form superficial palmar arch and a deep 
branch to complete deep arch. 

Locate and describe the ovaries. 

The ovaries are located ordinarily close to lateral part of 
true pelvic brim, attached to posterior layer of broad ligament. 
They somewhat resemble a broad almond, are iy 2 inches in 
length, whitish in color, with an uneven, puckered surface, 
and consist of a covering of germinal epithelium, and a stroma 
which encloses ovisacs, vessels and nerves. 

Locate and describe the principal convolutions of the 
brain. 

Ascending frontal convolution bounds the fissure of Rolando 
anteriorly, and belongs to the frontal lobe ; ascending parietal 
convolution bounds the fissure of Rolando posteriorly, and is 
a part of the parietal lobe. In these convolutions are located 
important motor nerve-centers, controlling nerves which are 
distributed to the opposite side of the body. 

The cuneus is a convolution belonging to the mesial surface 



ANATOMY. 53 

of the occipital lobe, between the internal parie to-occipital 
and calearine fissures ; in it are located the cortical centers 
of sight. 

Describe the palmar fascia. 

It consists of a central and two lateral portions. Central 
portion is thick and binds down tendons and protects vessels 
and nerves; it is narrow above where it is attached to an- 
terior annular ligament; below it is broad and divides into 4 
slips for the four fingers, these being attached to under 
surface of skin at base of fingers, to sides of metacarpo-phalan- 
geal joints and to sides oif metacarpal bones near their distal 
ends. 

Give the origin and insertion of the muscles of the 
scapulohumeral joint. 

Supraspinatus, infraspinatus, teres minor, subscapulars, 
deltoid, biceps and triceps. 

Supraspinatus : Origin, from inner % of supraspinous fossa ; 
insertion, into highest facet of greater tuberosity of humerus, 
and blending intimately with capsular ligament of shoulder 
joint. 

Infraspinatus : Origin, from inner % of inf raspinous fossa ; 
insertion, into middle facet of greater tuberosity, also blend- 
ing with capsular ligament. 

Teres minor : Origin, from upper % of axillary border of 
scapula ; insertion, into lowest facet of greater tuberosity, 
also blending with capsular ligament. 

Subseapularis : Origin, from greater part of subscapular 
fossa; insertion, into lesser tuberosity of humerus, its tendon 
of insertion also blending closely with capsular ligament. 

Deltoid : Origin, from outer % of anterior border of clavicle, 
from outer margin of acromion and lower border of spine of 
scapula; insertion, into rough, triangular area on outer side 
o'f shaft of humerus near its middle. 

Biceps : Origin, from coracoid process and from upper mar- 
gin of glenoid cavity (short and long heads, respectively) ; 



54 ANATOMY. 

insertion, into bicipital tuberosity of radius and by bicipital 
(or semilunar) fascia, into deep fascia of forearm. 

Triceps: Origin, from axillary border of scapula just be- 
low glenoid cavity (long; or scapular head), and from pos- 
terior surface of humerus, one head above, the other below, 
the musculo-spiral groove (2 short or humeral heads) ; inser- 
tion, into olecranon process of ulna. 

Describe the nasal fossae. 

Are 2 irregular cavities in middle of face, on either side 
Of mediau line, separated from each other by mesially placed 
nasal septum ; they extend upward to anterior floor of cranial 
cavity, and downward to roof of mouth ; they open anteriorly 
by 2 large apertures, the anterior nares, and communicate 
with naso-pharynx by posterior nares. 

Roof is narrow, and formed in center by cribriform plate 
of ethmoid, anteriorly by nasal bones and nasal spine of 
frontal, posteriorly by under surface of body of sphenoid. 
Roof contains apertures in cribriform plate for olfactory 
nerves ; behind are openings leading into sphenoidal sinuses. 

Floor is smooth, wider in middle than at either end, and 
is formed by palate process of maxilla, anteriorly, and by 
palate process of palate bone posteriorly. 

Inner wall consists of septum, which is made up of -crest 
of nasal bones and spine of frontal, by perpendicular plate 
of ethmoid, by vomer and by rostrum of sphenoid, and below 
by crests of maxillary and palate bones. A large notch at an- 
terior extremity of bony septum receives the septal cartilage. 

Outer wall is formed, in front, by lachrymal bone and nasal 
process of maxilla; in the middle, by ethmoid, inner surface 
of maxilla, and inferior turbinated; behind, by vertical plate 
of palate bone and internal pterygoid plate of sphenoid. The 
outer wall contains 3 irregular, longitudinal passages, viz., 
superior, middle and inferior meati; the superior meatus 
(smallest) is located at upper and back part of nasal fossa, 
is between superior and middle turbinated bones, and com- 
municates with spheno-maxillary fossa by spheno-palatine 



ANATOMY. 55 

foramen, and with posterior ethmoidal cells by an opening 
in its outer wall. (Opening for sphenoidal sinus is above and 
behind superior turbinated bone). Middle meatus is situ- 
ated between middle and inferior turbinated bones. It con- 
tains, anteriorly, the orifice >of the infundibulum, by which 
the middle meatus is placed in communication with the an- 
terior ethmoidal cells and the frontal sinuses; the middle 
ethmoidal cells and maxillary antrum also open into middle 
meatus. Inferior meatus is the largest, is formed by inferior 
turbinated above and floor of nasal fossa below ; it 'contains, 
under cover of the inferior turbinated, anteriorly, the termin- 
ation of the naso-lachrymal duct. 

Name and locate the accessory sinuses of the face and 
describe their outlets. 

Frontal isinuses, contained between outer and inner tables 
of frontal bone above supraorbital arch, communicate through 
infundibulum with anterior ethmoidal cells and middle nasal 
meatus. 

Ethmoidal cells, comprising greater part of lateral mass 
of ethmoid bone, and divided into anterior, middle and pos- 
terior. Anterior and middle ethmoidal cells open into middle 
nasal meatus; posterior ethmoidal cells open into superior 
nasal meatus. 

Sphenoidal cells (or sinuses) are contained within body of 
sphenoid bone and communicate with upper, back part of 
nasal fossa. 

Maxillary sinus (antrum of Highmore) is situated in body 
of maxilla; its outlet is an aperture communicating with 
middle meatus of nose. 

Describe the iris, giving relations, nerve and blood 
supply. 

It is an elastic, contractile diaphragm, forming the anterior 
extremity of the middle, pigmented and vascular tunic of the 
eyeball. By its peripheral attached border it is directly 
continuous with the ciliary body ; it is placed in front of the 



56 ANATOMY. 

crystalline lens, and incompletely divides the anterior cham- 
ber into two compartments. Near its center is a circular 
opening, the pupil, which varies greatly in size. In structure 
the iris consists of a stroma of delicate fibrous and elastic 
tissue, with perhaps some involuntary muscle fibres. It is 
supplied by the ciliary nerves. The long and anterior ciliary 
arteries anastomose and form a vascular circle around the 
attached margin of the iris, sending branches in toward the 
pupillary margin. 

Describe the course and distribution of the nerves of 
the palm of the hand. 

Median, from 'Outer and inner cords of brachial plexus, ac- 
companies brachial artery, rests upon flexor profundus digi- 
torum in forearm, passes beneath annular ligament into palm. 
It supplies all anterior forearm muscles except flexor carpi 
ulnaris and ulnar half of flexor profundus digitorum ; cuta- 
neous branches supply palm, thumb, index, middle and half 
of ring fingers on their palmar aspect and nail-beds, and outer 
two lumbricales. 

Ulnar, from inner cord, descends 'along inner border of 
arm, behind inner condyle o'f humerus, then between flexor 
carpi ulnaris and flexor profundus, both of which it supplies ; 
it crosses anterior annular ligament with ulnar artery and 
divides to supply short muscles of little finger, all interossei, 
inner two lumbricales and flexor brevis and adductor pollicis ; 
cutaneous distribution is to dorsum and palm of hand on 
ulnar side, and to little finger and ulnar half of ring finger. 

Give the origin, insertion and action of any one of the 
following muscles: digastric, sacrolumbalis, rectus ab- 
dominis. 

Rectus abdominis takes its origin from body of pubic bone 
and from anterior ligaments of pubic symphysis of opposite 
side, is inserted into costal cartilages of 5th, 6th and 7th ribs : 
contains three transverse lines (lineas transversa) , which 
extend in zigzag style across the muscle in its upper part; 



ANATOMY. 57 

action is to flex thorax upon pelvis, or vice versa, and to 
compress abdominal viscera. 

Give four principal points of distribution of the pneu= 
mogastric or par vagum nerve. 

Pharynx (motor), larynx (motor and sensory), heart 
(superficial and deep cardiac plexuses), stomach (uniting 
with sympathetic system) . 

What is contained in the middle mediastinum? 

Heart and pericardium, ascending aorta, lower part of 
superior cava, vena azygos major, both bronchi, pulmonary 
artery and veins, phrenic nerves. 

What anatomical parts are involved in the descent of 
the testes? 

Gubernaculum testes, visceral and parietal layers of peri- 
toneum, transversalis fasicia, inguinal canal and rings, internal 
oblique muscle (cremaster muscle and 'cremasteric fascia), 
intercolumnar fascia. 

Describe the bones forming the ossa innominata. 

Ilium has curved crest extending from anterior superior to 
posterior spine; internally is iliac fossa (false pelvis, limited 
below by ileo-pectineal line) ; externally are superior, middle 
and inferior gluteal lines; greater sciatic notch is behind, 
partly formed by ischium; anterior inferior spine for rectus 
femoris and ilio-femoral (Y) ligament is below anterior supe- 
rior spine ; ilium forms part of true pelvis and two-fifths of 
acetabulum; fuses with os pubis and ischium at 18th to 20th 
year ; articulates with sacrum by auricular surface. 

Ischium has a body above, with spine of ischium projecting 
backward and inward, and separating greater from lesser 
sciatic notches ; lesser sciatic notch is on ischium below spine ; 
tuberosity of ischium h lowest part, from which ramus as- 
cends toward pubic bone and partially bounds obturator 
foramen; ischium forms two-fifths of acetabulum and part 
of true pelvis. , 



o8 ANATOMY. 

Os pubis has body (articulates with opposite bone, forming 
symphysis pubis) ; horizontal .and descending ramus, bound- 
ing obturator foramen; pubic spine for Poupart's ligament; 
ilio-pectineal line extending from body along horizontal 
ramus; on under surface of latter is groove for obturator 
vessels and nerve. 

Describe the sternum, its articulations and the import= 
ant muscles attached to it. 

Consists of manubrium, gladiolus and ensiform appendix; 
suprasternal notch is above, between clavicles; notches are 
found along lateral borders for articulation of first seven 
pairs of ribs (costal cartilages), and at upper Outer angles 
of manubrium for clavicles; transverse ridge (subcutaneous 
landmark) exists at line of junction of manubrium and gladi- 
olus, marking level of third rib ; ensiform varies in size and 
shape. Important muscles attached are sterno-cileido-mastoid 
and pectoralils major; rectus abdominis and diaphragm are 
attached to ensiform. 

What portion of the bladder is uncovered by perito= 
neum? 

The anterior wall, which is separated from symphysis pubis 
by prevesical space (cavum Retzii). 

Describe the spinal cord. 

Is contained in neural canal, and extends from lower mar- 
gin of foramen magnum to body of second lumbar vertebra ; 
constitutes 2 per <cent. of cerebro-spinal axis; is surrounded 
by dura, (arachnoid and pia; has two enlargements, cervical 
and lumbar, which mark points of origin of large nerve trunks 
for upper and lower extremities respectively (brachial and 
sacral plexuses) ; white nerve matter surrounds gray, which 
is arranged like two inverted commas (or capital "H"), 
connected by transverse bland (gray commissure) ; anterior 
horn of gray matter contains large multipolar cells continuous 
with motor nerves, which appear upon surface of cord at 
antero-lateral aspect; posterior gray horn is continuous with 



ANATOMY. 59 

sensory nerves, which appear upon postero-lateral aspect of 
cord. 

Describe the hyoid bone. 

Is U-shaped, placed, with convexity forward, above thyroid 
cartilage ; consists of centrally located body, two greater cor- 
nua directed 'backward and two lesser cornua projecting up- 
ward at point of junction of body and greater cornua. Hyoid 
bone iserves for attachment of thyro-hyoid membrane and 
ligament and stylo-hyoid ligament; of sterno-hyoid, thyro- 
hyoid, omo-hyoid, genio-hyoid, genio-hyoglossus, hyoglossus, 
mylo-hyoid, stylo-hyoid and digastric muscles. 

Name the articulations of the superior maxillary bone. 

Frontal, lachrymal, nasal, malar, palate, ethmoid, inferior 
turbinal, vomer and opposite maxilla. 

Give the origin and distribution of the olfactory nerve. 

Olfactory tract appears upon surface of cerebrum 'at ante- 
rior perforated space, extends forward, terminating in olfac- 
tory bulb, which rests upon cribriform plate of ethmoid ; from 
under surface of bulb 20 to 30 nerves descend, enter superior 
nasal meatus, grooving perpendicular plate and superior and 
middle turbinal processes of ethmoid, iand are distributed to 
nasal mucous membrane covering these parts. 

Describe the mammary glands. 

Two hemispherical, lobulaited .glands placed upon anterior 
thoracic wall over pect oralis major muscle, covering a space 
from the second to the sixth rib, and from margin of sternum 
to anterior margin of axilla. Nipple, sensitive and pigmented, 
projects from center, and icontains orifices of lactiferous ducts ; 
areola, also pigmented, surrounds nipple; gland substance is 
arranged in lobules (10 to 20), each of which is a compound, 
racemose gland, and all are surrounded and supported by 
fibrous tissue, forming a capsule. 

Describe each of the tunics of the eye and the different 
parts of each. 

Sclerotic is outermost, consisting; of bundles of fibrous 



60 ANATOMY. 

tissue closely interlaced, is perforated to nasal side of pos- 
terior pole by optic nerve, and is continuous with cornea 
anteriorly. Six ocular muscles are inserted into it. Cornea 
is transparent, consists of bundles of fibrous tissue enclosing 
corneal spaces, in which are lodged corneal .corpuscles ; is 
covered by (conjunctival epithelium and lined by Descemet's 
membrane; is richly supplied by sensory nerve fibres, but is 
non-vascular. Uveal tract consiste of 'choroid, ciliary body 
and iris, is vascular and pigmented ; choroid is perforated by 
optic nerve behind; ciliary body is made up of ciliary pro- 
cesses and ciliary muscle; iris is placed in front of lens in 
anterior chamber, and is perforated at its center (pupil). 
Retina is innermost tunic, made up of nerve <cells and fibres, 
representing an expansion of the optic nerve; macula In tea 
is point of most acute vision, and is located to temporal side 
of optic disk, or point of entrance of optic nerve ; retina is 
.supplied by arteria centralis retinas, branch of ophthalmic 
artery, and drained by central vein of retina into ophthalmic 
vein. 

What are the vesiculae seminales? 

Two dilated pouches placed between bladder and rectum, 
uniting with vasa deferentia to form ejaculatory ducts. 

Give the course of the posterior tibial artery. 

Extends from lower border of popliteus muscle down leg 
between superficial and deep layers of muscles to inner side 
of ankle, where it divides into internal and external plantar 
branches. 

Which of the cranial nerves has the widest distribution? 

Pneum'ogastric (10th). 

Describe the origin and distribution of the ninth pair of 
cranial nerves. 

Ninth, or glosso-pharyngeal, nerve has superficial origin 
from groove between olivary and restif orm bodies of medulla ; 
is distributed to pharynx (sensory) and to posterior third 
of tongue, especially to circumvallate papillae. 



ANATOMY. 61 

Give the distribution of the radial nerve below the 
wrist. 

To radial half of dorsum of hand, and dorsum of thumb, 
index, middle and middle-finger half of ring finger, except 
distal segments of digits, which are supplied by median nerve. 

What is the linea alba and how is it formed? 

Is the line of fusion of aponeuroses of external and in- 
ternal oblique and transversalis muscles, extending from en- 
siform above to symphysis below; jus't below its center is 
umbilicus. 

Describe the sphincter ani. 

Are two in number, internal, or involuntary, and external, 
or voluntary. Internal is formed by circular fibres of rectal 
wall; external is attached to tip of coccyx, surrounds anal 
opening, and is inserted into median line of perineum. 

Describe the periosteum. 

Is closely adherent to ou'ter surface of bone and consists 
of two layers, an outer, fibrous layer, and an inner, vascular 
layer. In young and growing bones the inner is called the 
osteogenetic layer. Nerves and lymphatics are also present 
in periosteum. 

Give the origin, insertion and action of any one of the 
following muscles: tibialis anticus, pronator radii teres, 
gracilis. 

Tibialis anticus arises from upper % of outer surface of 
shaft and under surface of outer tuberosity of tibia, from 
interosseous membrane ; is inserted into internal cuneiform 
and first metatarsal bones; action, to flex and invert foot; 
to strengthen and help maintain antero-posterior arch of foot. 

Give a general description of the cerebral veins. 

Remarkable for thinness of their walls due to lack of muscu- 
lar tissue ; they have no valves ; superficial cerebral veins are 
lodged in sulci between convolutions, receive blood from sub- 
stance of brain and terminate in the sinuses, opening into 



62 ANATOMY. 

them in the opposite direction to which blood is flowing ; deep 
cerebral veins drain the ventricles into straight sinus; at 
base basilar vein drains interpeduncular space and basal 
ganglia. 

Relate the differences between a virgin uterus and the 
uterus of a multipara. 

Uterus of multipara is larger (especially body), arbor vitas 
uterinae of cervix is more or less effaced, external os is 
irregular, or perhaps stellate, instead of being a smoothly 
outlined, transversely directed slit. 

Describe a hair follicle in its relations to the skin. 

A hair follicle is an involution of epidermis, forming a 
funnel-shaped depression sometimes extending into subcu- 
taneous cellular tissue; is usually placed obliquely and be- 
comes enlarged at bottom to accommodate hair bulb, part of 
which is vascular papilla derived from dermal lining of 
follicle; opening into follicle are ducts of one or more se- 
baceous glands. 

What are the Wormian bones? 

Bones developed from separate centers of ossification to 
fill in gaps between certain of the cranial bones; they are 
found most frequently in latmbdoid suture, oiccasionally oc- 
cupying position of fontanelles, especially posterior. 

Give a general description of the peritoneum. Name 
the principal organs covered by it. 

Is a closed sac (except in female, at orifices of Fallopian 
tubes) which lines abdominal wall (parietal layer) and 
partially or completely surrounds viscera (visceral layer),, 
constituting their serous coat ; it forms omenta — Crastro-eolic, 
or great omentum, gastro-hepatic, or lesser omentum, and 
gastro-splenic ; it forms mesenteries — Mesentery (proper), of 
small intestine, mesocolon (ascending, transverse, descending, 
sigmoid, mesoappendix : principal organs covered by peri- 
toneum are; liver, stomach, spleen, small intestine, large- 
intestine, Fallopian tubes, uterus, bladder. 



ANATOMY. 63 

Describe the thymus gland. 

Is first found during second month of intrauterine life, 
is largest when child is two or three years old, and usually 
disappears before puberty ; is located in anterior mediastinum 
and lower part of neck, between lungs, in front of heart 
and great vessels and trachea ; consists of two lobes made up 
of lobules, which are essentially lymphatic in character. 

What are the suprarenal capsules and what are their 
relations to adjacent organs and parts? 

Are two in number, one placed upon the upper pole of 
each kidney; each consists of cortex and medulla with vessels 
entering and leaving at a hilum ; cortex is yellowish in color 
and contains granular, polyhedral cells arranged in columns ; 
medulla is darker in color, from presence of bloodvessels 
which are closely related to groups of large cells. Suprarenal 
bodies are partially covered by peritoneum and are in rela- 
tion, right with under surface of liver, left with spleen, 
stomach and pancreas. 

Describe the medulla oblongata. 

Is a part of encephalon, continuous with spinal cord be- 
low and with pons albove; it rests upon basilar process of 
occipital bone, consists of white nerve matter externally 
and gray matter arranged irregularly internally, the latter 
appearing upon the surface in floor of fourth ventricle, the 
lower half of which is formed by upper surface of medulla ; 
upon ventral surface is anterior median fissure, partially 
obliterated below by decussation of crossed pyramidal tracts ; 
near anterior part of inferior surface .are 'olivary bodies; 
posterior columns diverge to form calamus scriptorius and to 
bound fourth ventricle laterally for its lower half; postero- 
laterally are restiform bodies which can be traced upward 
into cerebellum, forming inferior peduncles of latter. 
Cranial nerves from seventh to eleventh inclusive arise from 
side of medulla, while twelfth appears upon surface in groove 
between olivary body and anterior pyramid. 



64 ANATOMY. 

Locate and describe the lachrymal gland. 

Is located in upper, outer and anterior part of orbit, to 
inner side of external angular process ; is made up of lobules, 
or clusters of acini, arranged around the ducts, six to twelve 
in number, which empty into outer part of superior con- 
junctival fornix. 

Describe the lungs. 

Each is pyramidal in shape, base resting upon diaphragm, 
apex extending into superior aperture of thorax, lateral, con- 
vex surface being applied to thoracic wall and inner, mesial 
and irregularly concave surface looking toward mediastinum ; 
each possesses a root, placed upon inner surface, near pos- 
terior, thickened margin, and consisting of bronchus, pulmon- 
ary artery and vein, (bronchial artery, nerves and lymphatics ; 
right lung has three lobes, left has two; each is made up of 
lobules consisting of a terminal bronchiole, around which are 
arranged clusters of air cells ; each lung is invested by visceral 
layer of pleura, whose parietal layer lines thoracic wall. 

Describe the structure of the knee=joint. 

Bones : Femur, tibia, patella ; ligaments : Internal and ex- 
ternal lateral, ligamentum patellae, posterior; these are 
strengthened and supported by aponeuroses of vastus externus 
and internal anitero-laterally, semimembranosus posteriorly; 
chief internal ligaments are crucial, anterior and posterior; 
joint contains two semilunar cartilages which are attached to 
non-articular area upon upper surface of tibia ; synovial mem- 
brane is extensive and complicated; movements: Flexion, ex- 
tension, slight rotation. 

Bound the popliteal space. Mention its contents. 

Above by outer and inner hamstrings, below by outer and 
inner heads of gastrocnemius muscle, with plantaris upon 
outer side; contents are: Internal and external popliteal 
nerves, popliteal vein and popliteal artery, termination of 
short saphenous vein and small lymphatic glands. 



ANATOMY. 65 

. Mention the principal branches of the celiac axis. 

Gastric, hepatic and splenic arteries. 

What are the nerves of the eyeball? 

Optic, motor oculi and ophthalmic division of fifth (both 
through ophthalmic ganglion) and sympathetic fibres from 
cavernous plexus (also to ganglion). 

Describe the aural labyrinth. 

Osseous labyrinth, whose divisions are three semicircular 
canals posteriorly placed, a vestibule in middle, and cochlea 
anteriorly, all containing memlbranous labyrinth upon which 
terminal filaments of auditory nerve and its special neuro- 
epithelium are found. 

Describe the popliteal artery and give its branches. 

Is a continuation downward of femoral from opening in ad- 
ductor -magnus and divides at lower border of popliteus 
muscle into anterior and posterior tibial arteries ; it lies upon 
femur, posterior ligament of knee-joint, tibia, and fascia cov- 
ering popliteus muscle; it enters popliteal space at upper 
inner margin, and bisects it longitudinally; popliteal vein 
is superficial to it ; branches are superior and inferior internal 
and external articular, iazygos articular, sural (muscular to 
calf), and anterior and posterior tibial. 

What are the blood=vessels which supply the arteries 
called? Whence are the nerves of the arteries derived? 

(a) Vasa vasorum. (b) Vasomotor, from sympathetic 
system. 

Mention the varieties of epithelium. 

Squamous, ^columnar, ciliated, glandular, transitional, pig- 
mented, and neuro-epithelium. The first three may occur in 
a single layer, when it is named "simple;" or, in several 
layers, when it is called "stratified." 

Describe the muscular tissue. 

Muscular tissue is of mesodermic origin and consists prin- 
5 



66 ANATOMY. 

cipally of elongated cells (fibrous cells) which have the in- 
herent power of contracting. The muscle fibres contain 
nuclei land, sometimes, that which corresponds to a cell wall,, 
the sarcolemma. Voluntary and cardiac muscles are striated, 
due to the arrangement of alternate light and dark discs. 
Non-striated muscle is involuntary. Microscopically, they 
may he differentiated as follows : 

Striated. Non=Striated. Cardiac. 

Fibers striated trans- No striations Striated longitudinally 

versely. ' and transversely. 

Has sarcolemma. Hyaline sheath. No sarcolemma. 

Nucleus beneath sarco- Nucleus in center. Nucleus oval and in 

lemma. center. 

Fibers do not branch, Fibers short. 

except in the tongue. Fibers branch freely. 

Describe a Haversian system. 

A Haversian system occurs in compact bone and consists 
of a system of channels through which the nutrient fluids 
pass. lit consists of the following : A centrally placed canal, 
the Haversian canal, which is surrounded by concentric lay- 
ers or plates o'f bone, the lamellae. Between the plates of 
bone are irregular clefts, the lacunae, which communicate with 
each other and with the Haversian canal by means of radially 
placed canals — the canalieuli. 

Name the humors of the eyeball. 

Aqueous humor, contained in anterior chamber, consists of 
98.6% water, and small quantities of extractives and pro- 
teids ; vitreous humor, occupying the large posterior chamber, 
has about the same composition as aqueous humor. 

State the origin of the sensory division of the fifth pair 
of cranial nerves. 

Superficial origin is from under surface of pons, close to 
anterior border. 

What is the function of the third cranial nerve? 

To supply With motor influence all ocular muscles except 



ANATOMY. 67 

superior oblique and external rectus, and to furnish motor 
root to ophthalmic ganglion. 

Describe the ramus of the jaw. Mention the muscles 
and ligaments attached to the ramus of the jaw. 

Ramus extends upward and slightly backward, forming 
angle o!f jaw by its junction with the body; is surmounted 
by coronoid process anteriorly and condyle posteriorly, be- 
tween which is sigmoid notch ; upon inner surface is inferior 
dental foramen. 

Muscles and ligaments attached are : Temporal, external and 
internal pterygoids, masseter; capsular and internal lateral 
ligament of temporo-mandibular articulation, stylo-mandibu- 
lar ligament. 

Describe the arytenoid cartilages. 

Are pyramidal in shape, rest upon upper, posterior part of 
cricoid cartilage by their bases, have true vocal cord (thyro- 
arytenoid ligaments) attached to vocal process anteriorly; 
lateral erico-arytenoid, posterior crico- arytenoid, arytenoid 
and thyro-arytenoid muscles are also attached. The arytenoid 
cartilages are covered with mucous membrane and between 
them is the interarytenoid space. 

Give the course and relations of the external jugular 
vein. 

- Is formed near angle of jaw by union of temporo-maxillary 
and posterior auricular veins, runs downward and outward 
upon sternomastoid muscle and under platysma myoides, to 
empty into subclavian vein at middle of clavicle. 

Mention the branches of the internal iliac artery. 

Anterior trunk: Superior, middle and inferior vesical, ob- 
turator, middle hemorrhoidal, uterine, vaginal, internal pudic 
and sciatic. From posterior trunk: Ilio-lumbar, gluteal, 
lateral sacral. 

Give the course of the female ureters. 

Rest upon psoas magnus muscles, pass over brim of pelvis 



68 ANATOMY. 

into cavity of same to base of (broad ligaments, then 
y 2 inch from cervix uteri, laterally, obliquely forward and 
inward in anterior vaginal wall to base of bladder. 

What nerves form the pharyngeal plexus? 

Glosso-pharyngeal, pneumogastric and cervical sympathetic. 

What structures are severed in tracheotomy? 

Skin, superficial and deep cervical fascia and trachea ; per- 
haps anterior jugular vein, or branches, and /thyroid isthmus. 

Describe the phrenic nerve. 

Is formed by the fourth cervical nerve, chiefly, passes down- 
ward upon anterior surface of scalenus anticus muscle, enters 
superior, then middle mediastinum and perforates diaphragm 
to supply its under surface. 

Describe the ulnar artery as to (a) origin, (b) course, 
(c) distribution. 

(a) Is one of terminal branches of brachial; (b) is beneath 
superficial flexors of forearm, passes obliquely to ulnar border, 
having ulnar nerve to ulnar side of it for lower % of its 
extent, then curves across palm near lower border of anterior 
annular ligament (superficial palmar arch), first sending 
communicating branch to deep arch, (c) Is distributed to 
structures around internal aspect of elbow, to ulnar side of 
forearm, to interosseous membrane, anteriorly and posteriorly, 
and adjacent muscles, and to palm and flexor surface of 
fingers. 

How are the saphenous veins formed? Where do the 
saphenous veins empty? 

Internal saphenous is formed upon dorsal surface of foot 
and inner border ; external saphenous is formed upon dorsum 
land outer border of foot. Internal saphenous vein empties 
into femoral at saphenous opening in fascia lata ; external 
saphenous terminates in popliteal vein. 



ANATOMY. 69 

Give the situation of the lymphatic glands of the thorax. 

Intercostal spaces posteriorly, anterior and posterior medi- 
astina, around bronchial tubes. 

Give the boundaries and mention the contents of the 
posterior mediastinum. 

Is bounded in front by pericardium and roots of lungs, 
behind by vertebral column and on either side by pleura. It 
contains descending thoracic aorta, greater and lesser azygos 
veins, pneumogastric and splanchnic nerves, esophagus, thor- 
acic duet and lymphatic glands. 

Describe the internal abdominal ring. 

Is oval in shape, long axis directed vertically, located in 
transversalis fascia y 2 inch above Poupart's ligament and 
midway between anterior 'superior iliac 'and pubic spines. 
Structures of spermatic cord pass through it in male, round 
ligament in female, Infundibuliform fascia is attached to 
its margin ; deep epigastric artery courses along inner margin. 

Give a method by which the fissures of Sylvius and 
Rolando may be approximately mapped out on the sur= 
face of the skull. 

Fissure of Sylvius : Draw a line from a point one inch and 
a quarter horizontally behind external angular process of 
frontal bone to a point % of an inch below parietal eminence. 
Fissure of Rolando : From a point y 2 inch behind mid-point 
of line between glabella and external occipital protuberance, 
draw a line for 3% inches over side of head at angle of 67° 
with median line. 

Locate and describe Peyer's glands. 

Are located in wall of ilium, more numerous at lower 
part; are more or less oval bodies collected together; con- 
sist of adenoid (lymphoid) tissue. 

Describe the tonsils and name some of the arteries 
which supply them with blood. 

Are placed between anterior and posterior palatine arches, 



70 ANATOMY. 

in tonsillar recess, close to base of tonigue, vary greatly in 
size and shape, surface is irregular and marked by numerous 
depressions leading into crypts in substance of tonsil, and are 
surrounded by closed follicles of lymphoid tissue. Arteries: 
Dorsalis linguae, ascending palatine and tonsillar of facial, 
descending palatine of internal maxillary, ascending pharyn- 
geal. 

Describe the male urethra and state its divisions. 

Divided into prostatic, membranous and spongy portions; 
prostatic passes through prostate gland, has veru montanum 
and orifices of ejaculatory ducts in its floor, upon either 
side of which are prostatic sinuses with orifices of prostatic 
glands ; membranous portion is shortest of the three, is con- 
tained between the two layers of triangular ligament, and 
surrounded by compressor urethras muscle ; spongy portion is 
contained in corpus spongiosum, terminates iat meatus urin- 
arius externus (least dilatable part of urethra) and has 
several depressions in mucous membrane of roof, largest 
of which, just behind fossa mavicularis, which is close to 
meatus, is name'd lacuna magna. 

What is the origin and course of the pulmonary artery? 

Origin is from right ventricle; course is upward and 
slightly to left to under surface of transverse portion of 
aortic arch, where it divides into right and left pulmonary 
arteries for right and left lungs respectively. 

Give the names of the principal muscles of the back. 

Trapezius, latissimus dorsi, rhomboideus major and minor, 
erector spinse. 

Locate and describe the rectum. 

Extends from third piece of sacrum to anus, with forward 
curve, is covered by peritoneum in front and on the sides 
only; lon^ituldinal and circular muscular fibres pronounced; 
mucous membrane thick, presenting several permanent, trans- 
verse folds, plica? recti, or valves of Houston ; is supplied by 



ANATOMY. 71 

superior, middle and inferior hemorrhoidal arteries; is be- 
hind bladder and prostate in male and vagina in female. 

Where does the abdominal aorta commence and where 
does it terminate? 

Commences at aortic opening in diaphragm upon body of 
twelfth thoracic vertebra; terminates upon body of fourth 
lumbar vertebra, just to left of median line. 

Where is the foramen ovale of the heart and what 
purpose does it serve? 

In the wall between the auricles; permits passage of blood 
in the foetus from right to left auricle, deflecting its course 
from right ventricle and pulmonary circulation into general 
circulation. 

What are the lymphatic glands? 

Parts of lymphatic system consisting of adenoid tissue, 
enclosed in capsule, having afferent and efferent lymphatic 
vessels; lymph passes through them. 

Describe the changes in the vascular system at birth, 

Blood ceases to flow through umbilical vein and ductus 
venosus into inferior cava; hypogastric arteries become ob- 
literated; foramen ovale closes and blood then does not pass 
from right to left auricle; ductus arteriosus, connecting pul- 
monary artery with arch of aorta becomes impervious and 
pulmonary circulation is actively established. 

In the anatomy of the brain what is the corpus callo= 
sum? Describe its connections. 

The great transverse commissure consisting of fibres which 
-pass from one hemisphere to the other, connecting different 
parts of the cortex of one with that of the other, is located 
nearer the base than the top and forms the roof of the lateral 
ventricles. 

Mention a muscle (a) which moves the thumb outward, 



72 ANATOMY. 






(b) which moves the head forward, (c) which moves the 
foot inward. 

(a) Abductor pollieis; (b) sterno-eleido-mastoid (rectus 
capitis anticus major) ; (c) tibialis antieus. 

What is the composition of intervertebral substance? 
How much of the spinal column does this substance form? 

Is made up of fibre-cartilage; constitutes about 14 of the 
spinal column. 

Give the boundaries of the anterior mediastinum. 

In front by the sternum, behind by the pericardium, later- 
ally by the pleurse. 

What are the ciliary processes in the eye? Where are 
they placed and what is their average number? 

Folds of 'middle tunic (uveal tract) consisting of con- 
nective tissue, blood vessels and pigment; are placed around 
periphery of lens close to edge, posteriorly, and number about 
seventy. 

State the action of each of the following muscles: mas= 
seter, tibialis anticus, gluteus maximus. 

Masseter, to bring lower jaw up against upper jaw ; tibialis 
anticus, to flex foot upon leg and elevate and adduct liraer 
border of foot ; gluteus maximus, to extend trunk upon thigh\ 
or thigh upon trunk. 



PHYSIOLOGY. 



Describe the bi!e=producing and the glycogenic function 
of the liver. 

Bile is produced by the activity of the liver cells chiefly 
from the blood from the portal vein. It is collected in little 
canals hollowed between the cells and emptied into the bile 
capillaries. Through these it is forced on into the bile duct 
and either passed on into the duodenum during the act of 
digestion, or stored in the gall bladder until needed. 

Glycogen or animal starch is formed by the protoplasmic 
activity of the liver cells from proteids and carbohydrates. 
It is deposited in the liver cells and when needed is changed 
into dextrose by a 'diastatic ferment found in the blood of 
the liver. This dextrose is carried out in the blood of the 
hepatic vein into the general circulation. 

Give a dietary for people beyond the age of sixty years. 

Food for the aged should be readily digestible and capable 
of being easily burned up for the maintenance of the heat 
of the body. Among suitable articles are eggs, milk, rice, 
properly cooked beef, butter and bread. 

What is the function of the cerebellum? 

The function of the cerebellum is the co-ordination of 
muscular movements. 

Describe ciliated epithelium and state where it is found 
most abundantly. 

The cells of ciliated epithelium are generally columnar in 
shape with numerous fine filaments projecting from their free 
surface. Ciliated epithelium is found most abundantly in the 

(73) 



74 PHYSIOLOGY. 

trachea arudi bronchi and here sweeps the mucus and small 
dirt particles toward the mouth. 

Give a description of the act of deglutition and mention 
the muscles brought into action in swallowing. 

The swallowing- of solids is divided into three stages — 
buccal, pharyngeal and esophageal. The first is voluntary, 
the others involuntary. The food is formed into a bolus and 
pressed backward by the tongue into the pharynx ; the nasal 
cavities being closed, the pharyngeal muscles contract and 
force it on down to the esophagus. This in turn contracts 
and by <a peristaltic movement forces the bolus into the 
stomach. 

Liquids iare not swallowed in this way, but are squirted 
down the esophagus, with a bulb syringe effect, by the 
mylohyoid muscle. The muscles involved in deglutition are 
the mylohyoid, muscles of the tongue, pharyngeal muscles, 
especially the constrictors and the involuntary muscular 
fibers of the esophagus. 

How is asphyxia produced? What are the causes of 
death from asphyxia? 

It is produced by anything causing a deficiency in the 
supply of oxygen to the tissues, 'as edema of lungs, membran- 
ous laryngitis, constriction of the trachea. 

Death is caused by a deficiency in the amount of oxygen 
and the 'accumulation of carbon dioxide in the blood. The 
respiratory center is probably the first one to be disabled. 

Describe (a) chyme, (b) chyle. 

Chyme is the acid semi-fluid mass of partially digested food 
passing from the stomach into the duodenum. 

Chyle is the lymph found in the lacteals of the intestines 
containing the absorbed fat. It is a milky white, alkaline 
fluid. 

Give the process of coagulation of blood. 

The fibrin ferment formed by the disintegration of the 



PHYSIOLOGY. Id 

white corpuscles acts upon the fibrinogen and converts it, if 
calcium salts are present, into the insoluble fibrin. The 
fibrin is formed in little filaments all through the blood 
and immeshes the blood corpuscles. This forms the clot 
which gradually begins to contract, A liquid called serum 
soon exudes and collects over the clot, 

Name the functions of the chorda tympani, sufficiently 
detailing each to clearly define its character. 

The chorda tympani contains the vasodilator fibers, but 
no vasoconstrictor fibers, for the anterior tongue and sub- 
maxillary gland. It contains the secretory fibers to the sub- 
maxillary gland, and also the taste fibers for the anterior 
two-thirds of the tongue. 

Name the groups of food stuffs constituting the source 
of muscular energy. Designate the most important and 
state what stored product is utilized. 

Carbohydrates are the most important, but fats and pro- 
teids may be used in the production of muscular energy. 
Glycogen is the stored product that is utilized. 

State the function of the nervus opticus, and explain by 
description or diagram the distribution of the fibers com= 
posing the chiasma and the effect thereof upon vision. 

The nervus opticus is the nerve of the special sense, sight. 

At the chiasma, the inner half of each optic nerve crosses 
to the opposite side ; therefore, in loss of function of one optic 
nerve from injury or pressure hack of the chiasma, there is 
blindness of the temporal side of retina of the same eye and 
of the nasal side of opposite eye. Stimulation of one retina 
by light causes a reflex contraction of both pupils. 

Describe metabolism. 

Metabolism is the chemical change going on in organized 
tissue. There are two divisions — anabolism or building up, 
and katabolism or tearing down. This chemical change is 
.usually a hydration, dehydration, reduction or oxidation. 



76 PHYSIOLOGY. 

In the metabolism of proteids of the tissue, proteid food 
must be used to repair the loss. 

The carbohydrates are the substances most readily broken 
up to supply heat and energy, the fats being next in order. 
The salts are needed in the various processes, but especially 
to combine with the acids, sulphuric and phosphoric, formed 
in proteid katabolism. 

What is the normal proportion of blood in the human 
body and how is it renewed after hemorrhage? 

About one thirteenth of the body weight is blood. The 
water and other constituents of plasma are renewed from the 
ingested food. The corpuscles are renewed by the bone mar- 
row, spleen and lymphatic tissues. 

State the effects of battery currents on the normal 
human nerves. 

The f aradic current stimulates them. 

A nerve during the passage of a constant current through 
it, is said to be in a state of electrotonus. There is an in- 
crease of excitability at the negative pole or kathode, and 
decrease of excitability at the positive or anode. 

Give the relative food value and ease of digestion of 
meat, milk, eggs, leguminous fruits. 

According to relative food value the order is — meat, eggs, 
milk and leguminous fruits. 

According to relative ease of digestion the order is milk, 
eggs, meat and leguminous fruits. 

What are the effects of removal of the cerebrum in the 
lower animals? 

A decerebrated animal loses all power of voluntary move- 
ment, remaining quiescent until some external stimulus; brings 
out a reflex movement. Thus, food may be placed before 
him, but he will not take it ; if it is placed in his mouth, he 
will swallow it. If turned on his back, he will right him- 
self. He shows no fear. 



PHYSIOLOGY. 11 

What conditions are necessary for properly exercising 
the sense of smell? 

For the proper exercise of the sense of smell, the sub- 
stance must be volatile, the air in the nasal cavity must be 
in motion, and the olfactory apparatus must be in normal 
condition. 

How would digestion be affected were the ductus com= 
munis choledochus obstructed? 

In obstruction of the ductus communis choledochus the 
feces contain large quantities of undigested fats, the stools 
become hard and fetid, and finally death ensues from ab- 
sorption of putrefactive products from the intestines. 

Give the mechanism of the diaphragm in (a) respiration, 
(b) hiccough. 

During rest or relaxation the diaphragm is domed upward. 
During inspiration, the muscle contracts, the central tendon is 
pulled down and thus the vertical diameter of the thorax is 
increased. During expiration, the muscle relaxes and the 
diaphragm resumes its domed position. 

Hiccough is caused by a sudden spasmodic contraction of 
the diaphragm, the inspiration thus caused being arrested 
by a sudden closure of the glottis. 

How does the nervous system influence gastric diges= 
tion? 

Through the vagus the secretion of the stomach is con- 
trolled from the central nervous system. The vasomotor 
nerves of the stomach also influence secretion by controlling 
the mount of blood to the stomach. 

Give the physiology of (a) hunger, (b) thirst. 

Hunger is the constitutional need of the body for food 
with the eccentric symptoms in the epigastrium. The im- 
poverishment and changes in the blood so affect the central 
nervous system as to cause the sensation. 

Thirst is the constitutional need of the body for water 



78 PHYSIOLOGY. 

with the eccentric symptom in the pharynx. The lack of" 
water in the blood so -affects the nervous system as to cause 
this dryness of the throat. 

Give the foramen of exit, the distribution and the func= 
tion of the pathetic (fourth cranial) nerve. 

The pathetic or trochlear nerve 'passes out through the 
sphenoidal fissure and is the motor nerve of the superior 
oblique. 

Give the process of development of the parietal bone. 

The parietal bone is formed between membranes and is not- 
preceded by temporary cartilage. 

The membrane is formed of an external fibrous layer and 
an internal layer, which becomes the periosteum and consists 
of a layer of osteoblasts. 

.Starting from a point called the center of ossification, little 
spicules of bone are deposited in all directions in the inter- 
cellular substances. iAs they become more numerous, they 
completely enclose the osteoblasts, which remain permanently 
in the bone. This process spreads in all directions and thus 
the bone is formed. 

Explain the physiological circuit essential to a reflex 
action. 

The essentials are an afferent nerve, a nerve center, an 
efferent nerve and the peripheral organ which it supplies. 

Mechanical irritation of the sensory fibers of the vagus in 
the mucous membrane of the stomach causes an increased 
flow of saliva by irritation of the salivary center in the 
medulla and consequent passage of efferent impulses to the- 
salivary glands. 

What is the function of the sixth (abducens) nerve? 

The abducens is the motor nerve of the external rectus. 

Describe the respiratory function of the red blood cor- 
puscles. 

"When the venous blood reaches the capillaries sur- 



PHYSIOLOGY. 79 

rounding the air vesicles of the lung, the hemoglobin found 
in the red corpuscles rapidly combines with the absorbed 
oxygen to form oxyhemoglobin. This is carried back to the 
heart and then into the systemic circulation, finally reaching 
the capillaries. Here the tissues take the oxygen from the 
loosely combined oxyhemoglobin. The hemoglobin is then 
carried back to the lungs to be reoxygenated. The cor- 
puscles also carry small amounts of carbon dioxide from the 
tissues to the lungs. 

Describe the normal pulse; state the factors active in 
its maintenance, and give the average rate during infancy, 
youth and adult age. 

The pulse is the transmission of the cardiac impulse through- 
out the arterial system. A normal pulse should be full, of 
moderate tension, regular and of the right frequency. It is 
ordinarily examined over the radial artery at the wrist, 
because in this position there is a hard surface against which 
Ave can press the artery. 

The factors active in its maintenance are the normal action 
of the heart and of the vasomotor system. 

The average rate during infancy is 130 to 140; during 
youth 80 to 90 ; during adult life 70 to 75. 

Name the active principles of the digestive secretions 
and state how each affects the food. 

Ptyalin of saliva changes starch into maltose. 

Pepsin, when hydrochloric acid is present, changes proteids 
into proteoses and peptones. 

Rennin changes caseinogen into casein. 

Amylopsin changes starch into maltose, dextrose, and dex- 
trin. 

Steapsin splits up fat into fatty acid and glycerin. 

Trypsin, in an alkaline medium, changes proteids into 
proteoses 1 and peptones. 

Invertin changes maltose into dextrose, and saccharose 
into equal parts of dextrose and levulose. 

Bile contains no ferment, but aids the pancreatic secretion 
in the emulsification of fats. 



80 PHYSIOLOGY. 

From what portions of the cortex cerebri do the arm, 
face and leg receive their motor impulses? 

The motor area is along the fissure of Rolando in the as- 
cending frontal, ascending parietal >and paracentral convolu- 
tions. The leg center is the uppermost, the arm center next, 
and the face center the lowermost. 

Describe the position of the vocal chords during phona= 
tion and name the factors concerned. 

The chink of the glottis during phonation is narrowed, 
the arytenoid 'Cartilages are approximated and the vocal cords 
are stretched. The arytenoid' muscle approximates the ary- 
tenoid cartilages, and with the help of the lateral 'crico-ary- 
tenoids and the internal part of the thyro-'arytenoids closes 
the glottis. The vocal cords are made tense by the crico- 
thyroids and external part of the thyro-arytenoids. 

Give the origin of normal fat in the human body and 
name examples of the types of food from which it is 
elaborated. 

The normal fat of the body is derived from food ingested. 
Any excess of food is stored up as fat. Fat may be elabor- 
ated from fats ingested as olein, from carbohydrates as starch, 
or from proteids as casein. 

Describe a complete physiological revolution of the 
heart. 

During diastole the blood from the auricles passes into 
the ventricles. Toward the end of diastole the auricles 
contract, forcing the blood remaining in them into their 
respective ventricles ; the ventricles now 'contract, the auriculo- 
ventricular valves are closed and the blood is forced into the 
pulmonary artery and aorta through the open semilunar 
valves; the ventricles now relax, the semilunar valves clos- 
ing with a snap and the auriculo- ventricular valves being 
opened by the force of blood in the auricles and by the nega- 
tive pressure in the ventricles. 






PHYSIOLOGY. 81 

If the cardiac revolution were divided into tenths, the first 
or systolic sound would occupy four-tenth's, the short silence 
one- tenth, the second or diastolic sound two- tenths, and the 
long silence three-tenths. 

Describe the process of respiration. 

Respiration is the function of taking in oxygen and the 
throwing off carbon dioxide. This exchange of gases takes 
place in the air vesicles where the blood and atmospheric air 
are separated by but a single layer of squamous epithelium. 

Three factors are concerned in this exchange — the law of 
pressure of gases, chemical affinity, and the vital activity 
of the epithelium. 

In tissue respiration the oxygen passes through the endo- 
thelium forming the capillary wall, into the tissue, where it is 
used up. The carbon dioxide there formed passes from the 
tissues into the capillaries and thence to the lungs. 

What are the functions of the blood=vessels? 

Through the blood-vessels the blood is forced to the various 
parts of the body, carrying nutritive products to the tissues 
and waste from the tissues to the organs that excrete it. By 
their muscular wall they regulate the amount of blood going 
to various portions of the body, and together with the elastic 
tissue they contain also reduce the amount of work thrown on 
the heart. Through the capillary wall osmosis and diape- 
desis take place. 

Name and describe the normal respiratory sounds of the 
lungs and bronchi. 

The vesicular sound is a distant, soft, breezy sound, of 
low pitch, with the inspiration three or four times longer 
than expiration. It is caused by air passing through the 
bronchi, the sound being modified by the air vesicles. The 
bronchial sound is caused by the air rushing in and out of 
the bronchi. It is high pitched, loud, tubular in quality, the 
expiration being to inspiration as seven is to six. 
6 



82 PHYSIOLOGY. 

Of the functions of vision, what is understood by ac= 
commodation? 

By accommodation is meant the increasing of the curvature 
of the anterior surface of the crystalline lens to focus near 
Objects on the retina. 

Describe the action of the kidneys, and give the normal 
constituents of the urine. 

The kidneys are compound tubular glands that pick out 
from blood certain waste material which passes down the 
tubules injto the pelvis of the kidneys and then into the 
bladder. 

But one constituent of the urine is formed in the kidney 
and that is hippuric acid. 

The water niters through the glomeruli principally, while 
the urea is picked out by the rodded epithelium of the con- 
voluted tubules. No proper secretory nerves have as yet been 
found for the kidneys, which seem rather to be controlled by 
the vasomotor system. The kidneys have possibly an in- 
ternal secretion also. 

The normal constituents of the urine are — water, urea, 
uric acid, hippuric acid, sodium chloride, potassium and 
sodium sulphates, conjugate sulphate as indican, earthy and 
alkaline phosphates, sometimes carbonates and oxalates, and 
the coloring matters urochrome, urobilin and uroerythrin. 

Describe gastric digestion, with special reference to the 
changes effected upon the types of food. 

When the food reaches the stomach the two openings close 
and the involuntary muscle contracts down on the mass and 
starts up a churning-like movement, by which fresh portions 
of food are constantly brought to the surface. At the end 
of an hour the pyloric orifice gradually relaxes, allowing some 
olf the more liquid chyme to pass into the duodenum, and by 
the end of three or four hours even the larger pieces of un- 
digested food are forced into the duodenum. During this 
time the gastric juice is being poured out from the mucous 
membrane. The act of mastication and deglutition and the 



PHYSIOLOGY. 83 

irritation of sensory vagus endings in the stomach by the food 
act as powerful reflex excitants to this secretion. 

The ptyalin of the saliva continues to change starch into 
maltose until the increasing acidity of the gastric juice stops 
its action. 

The fats are liquified, but it is upon the proteids that the 
chief action takes place. The rennin changes easeinogen 
into casein. The pepsin in the presence of the hydrochloric 
acid changes the proteids into proteoses and peptones. 

Describe the process of segmentation of the ovum. 

The impregnated ovum first divides into two cells by in- 
direct division or karyokinesis, these again subdivide, con- 
tinuing until finally a single layer of cells surrounding a 
central cavity is formed. One group of cells proliferates 
more rapidly than the other and as a result they become sur- 
rounded by the other layer; thus two leaves are formed. 
Between these a third layer or mesoblast is formed. From 
this blastoderm the animal is now developed. 

What is the relation of the capillaries to the circulation? 

The capillaries connect the small arterioles with the small- 
est veins. They are situated at the periphery. 

What precautions should be taken in the ingestion of 
vegetable foods? Give the reasons for taking these pre= 
cautions. 

Vegetable foods should be well cooked so as to burst the 
cellulose covering of the starch granules; they should be 
well chewed so as to break up the cellulose covering. Some 
fatty food should be taken with them as they are deficient 
in fats. As some of them contain but little nutritive ma- 
terial, they should be taken in large quantities for obvious 
reasons. 

Describe the process of osmosis and give examples in 
the human economy. 

Osmosis is the diffusion of liquids through a porous mem- 
brane. 



84 PHYSIOLOGY. 

For osmosis to take place the liquids must be miscible, of 
different natures, capable of wetting the membrane without 
acting on it chemically, and the substance must be able to 
pass through the membrane, that is, be crystalloidal in nature. 
Heat, increase of pressure and electricity aid osmosis. 

The following are examples of osmosis: (1) The passage 
of some of the plasma through the capillary wall into the 
tissues. (2) The passage of glucose from the intestine into 
the poral circulation. 

Name the secretions of the alimentary canal and give 
the functions of each. 

Saliva changes starch into maltose and dextrin, dissolves 
soluble substances, thus 'allowing them to be tasted, lubricates 
the bolus of food and aids in speech. 

Gastric juice changes caseinogen into casein, and proteids 
into proteoses and peptones. It also destroys many micro- 
organisms swallowed in the food. 

Pancreatic secretion changes proteids into proteoses and 
peptones, starch into maltose, dextrose, and dextrin, casein- 
ogen into casein, and splits up, saponifies and emulsifies fats. 

Bile neutralizes the acid chyme precipitating the pepsin, 
aids in the emulsincation and absorption of fats, increases 
peristalsis, and carries off some of the waste thrown out by 
the liver. 

Suecus entericus changes maltose into glucose, and sac- 
charose into invert sugar. 

The alimentary canal has also the usual protecting and 
lubricating secretion of mucus. 

Describe urea, its occurrence, variations in the quantity 
excreted and recognition in the voided urine. 

Urea, CO(NH 2 ) 2 , the great nitrogenous waste, is a crystal- 
lizable substance soluble in water, less soluble in alcohol, neu- 
tral in reaction and forming with nitric acid urea nitrate. 
About 500 grains daily are thrown, off in the urine by the 
kidneys. It is formed in the liverXi) and in the intestines 



PHYSIOLOGY. 85 

(\). It varies principally with the amount of nitrogenous 
food in the diet. Muscular exercise does not increase it 
to any marked extent. It is recognized by adding nitric acid 
to a concentrated urine, when urea nitrate separates out in 
a crystalline mass, also by the hypobromite test. 

What is rigor mortis? What is tetanus? 

Rigor mortis is the post-mortem rigidity of the muscles due 
to the coagulation of the myosinogen. 

Tetanus is a state of continued contraction of a living 
muscle. 

Give the varied functions of the sympathetic nerve. 

The function of the sympathetic system is mainly vaso- 
motor. It also supplies the heart with accelerating fibers, 
the intestines with inhibitory and some motor fibers; dilates 
the pupil, and causes a bulging of the eyeball. It also has 
an influence on the salivary secretion. 

How are the phenomena of ventriloquism produced? 

Instead of the usual expiratory blast, an inspiratory blast 
is used in producing the vocal sounds. At the same time 
the operator directs the attention of the onlookers to some 
object. 

Describe the mechanism of micturition. 

Usually it is a mixture of a voluntary and involuntary re- 
flex act. The reflex center is situated in the lumbar cord. 
Stimulation of this center is ordinarily caused by a full 
bladder or by the escape of a drop of urine into the urethra, 
but may be excited by irritation of sensory nerves of other 
surfaces, as the intestinal mucous membrane by worms. 
Ordinarily the sphincter of the bladder is inhibited, the 
muscular wall contracts, and aided by the abdominal and 
other expiratory muscles forces the urine out through the 
urethra, There are higher centers that have control over 
the lower reflex centers. 



86 PHYSIOLOGY. 

Name the ferments that are the essential constituents 
of each digestive fluid. 

Ptyalin is found in saliva; pepsin and rennin in gastric 
juice; amylopsin, steapsin, trypsin and a milk-curdling fer- 
ment in the pancreatic juice ; invertin in the succus entericus ; 
and the micro-organisms or organized ferments in the in- 
testines. Bile contains no ferment. 

What are the functions of the spinal cord? 

The spinal cord is the great motor and sensory pathway 
to and from the periphery. In the anterior horns are found 
the cells concerned in the muscular reflexes, and also the 
trophic centers for the muscles. Beside the muscular reflex- 
centers, the cord contains the following centers: Anospinat, 
vesicospinal, genitospinal, uterospinal, sweat, minor vaso- 
motor and possibly ciliospinal. 

What postmortem tests should be applied to prove that 
air has entered the lungs of a supposedly still=born child? 

Tie the trachea, take out the lungs and place them in 
water. If they float, air has entered the lungs, The thorax 
is not as flat after respiration has started and the diaphragm 
is displaced further downward. The lungs are 'brighter in 
color and are crepitant after air has once entered. 

Wherein does the temperature of the body in advanced 
age differ from its temperature in middle life? 

In advanced age the' temperature has a tendency to be- 
come subnormal from the slightest cause. 

Give in language or by drawing the sphygmographic 
tracing in aortic insufficiency. 

In aortic insufficiency there is the so-called "trip hammer 
pulse. ' ' In the sphygmogram there is a very high, quick up 
stroke 'and an almost as quick downstroke due to the rapid 
decrease in pressure caused by the regurgitation. On the 
downstroke a small dicrotic wave is seen. 



PHYSIOLOGY. 87 

What are amyloid foods, proteid foods? Give three ex= 
amples of each. 

The amyloid foods are the carbohydrates in the molecule 
of which are six or multiple of six atoms of carbon, and 
hydrogen and oxygen in the proportion to form water. 
Starch, cane sugar and glycogen and amyloids. 

Proteids are highly complex bodies containing carbon, 
hydrogen, oxygen, nitrogen, sulphur and sometimes phos- 
phorus. Egg albumen, casein and gluten are proteids. 

How is cartilage (a) developed, (b) nourished? 

Cartilage is developed from the mesoblast. The cells are 
not branched. By karyokinetic changes they divide and 
subdivide. Each cell is surrounded by a capsule which helps 
to form a portion of the matrix. But beside this, other 
material is deposited in the intercellular spaces. 

Cartilage is nourished by the perichondrium except arti- 
cular cartilage, which is nourished from the underlying bone. 

Describe nerve cells and nerve fibers. 

The nerve cells are nucleated masses of granular proto- 
plasm with one or more protoplasmic prolongations called 
dendrons. Passing off from most nerve cells is a long fiber 
or axis cylinder. 

The nerve fibers are either medullated or non-medullated. 
The medullated fibers consist of an axis cylinder or neur- 
axon, surrounded by the myelin or white substance of 
Schwann, which in turn is covered with the neurilemma or 
sheath of Schwann. An internal layer of protoplasm sepa- 
rates the myelin from the neuraxon, and an external layer 
separates the myelin from the neurilemma. Here and there 
along the course of the nerve are found the nodes of Ranvier. 
The non-medulla-ted fibers contain no myelin. 

What experiments have been made to prove the glyco= 
genie function of the liver? 

The blood of the portal vein during active digestion of a 



88 PHYSIOLOGY. 

carbohydrate meal contains more sugar than the hepatic 
vein, showing the arrest of dextrose in the liver. The hepatic 
vein in the intervals of digestion contains twice as much 
dextrose as that in the Mood entering the liver. 

If a rabbit that has been fed on carrots is killed and the 
liver rapidly removed, cut into small pieces and thrown into 
boiling water, it yields an extract rich in glycogen and al- 
most free of dextrose. 

If another animal is treated the same but the liver al- 
lowed to stand for some time before making an extract, the 
extract will contain much dextrose and but little glycogen. 

The carbohydrate of blood is dextrose and not glycogen. 
Under the microscope, glycogen granules are found in the 
protoplasm of the liver cells. 

Give the function of the epiglottis. 

The epiglottis is used in vocalization, especially of the 
lower-pitched tones. 

What differences of function exist between the white 
and gray matter of the encephalon? 

The gray matter is composed of cells, which are the ter- 
minals that receive sensations, classify the knowledge thus 
received, and send out impulses. 

The white matter is made up of fibers that transmit the 
impulses, connecting the cells with each other and with the 
periphery. 

Describe the ileocecal function. 

The ileocecal valve is composed of two semilunar folds 
of mucous membrane, containing the circular fibers. When 
the cecum is distended this valve is closed, and thus re- 
gurgitation into the small intestine is prevented. 

State the approximate time of eruption of the tempo= 
rary teeth. 

The lower central incisors erupt about the 5th or 6th 
month, followed rapidly by the other six incisors. About 



PHYSIOLOGY. 89 

the 11th. or 12th month the first molars appear. From the 
18th to 20th month the canines erupt, followed from the 
24th to 30th month by the second molars. 

State what are, under normal conditions, the (a) adult 
number of respirations per minute; (b) body tempera= 
ture; (c) average respiratory capacity. 

Respiratory rate is eighteen per minute; the body tem- 
perature is 98.4° Fahr. ; the average respiratory capacity is 
230 cubic inches. 

Name two circumstances influencing secretion. 

Among circumstances influencing secretion are the supply 
of blood to the gland and the proper action of the normal 
reflex excitants. 

What is the function of (a) sudoriferous glands; (b) 
the sebaceous glands? 

The function of the sudoriferous glands is to excrete 
sweat; that of the sebaceous glands to secrete sebum. 

Name the principal centers of organic function in the 
medulla oblongata. 

The principal centers in the medulla are the respiratory, 
cardio-inhibitory, cardio-aecelerator, vasomotor, salivation, 
mastication, deglutition, vomiting and diabetic. 

Account for the contraction and dilatation of the pupil. 

The contraction and dilatation of the pupil is a reflex 
phenomenon regulating the amount of light and sharpening 
the image for near objects. 

There are two sets of muscular fibers in the iris — circular or 
contracting and radiating or dilating. 

Give the composition of normal feces. 

The feces contain 70 to 80% of water. Of the solid mat- 
ter there are indigestible substances as cellulose, mucin and 
keratin ; some undigested matter as uncooked starch and 
elastin; products of microbic digestion as indol, skatol, 



90 PHYSIOLOGY. 

phenol, fatty acids and leucin; bacteria; cholesterin; color- 
ing matters, stereobilin ; and intestinal debris as cells and 
mucus. They are alkaline in reaction, quantity, 6 to 8 ounces 
in 24 hours. 

Describe the disturbances of function produced by the 
excessive imbibition of alcohol. 

Excessive imbibition of alcohol causes congestion of the 
stomach with altered gastric secretion, precipitation of pepsin 
during gastric digestion, congestion of liver and finally de- 
struction, of many of the liver cells. On entering the cir- 
culation it acts as an irritant to the whole vascular system 
and to the kidneys. It also causes subnormal temperature. 

How are cells connected? 

Cells are connected by the intercellular substances. 

What changes take place in the composition of blood as 
it passes through the kidneys? 

During the passage of the blood through the kidneys, these 
organs pick out of it large quantities of urea, uric acid, 
sodium chloride, alkaline and earthy phosphates, sodium and 
potassium sulphates, indican, extractives and water. The 
blood also becomes venous, losing oxygen and adding more 
carbon dioxide. 

How are the vocal sounds produced? 

The vocal sounds are produced by vibrations of the vocal 
cords, modified in the case of vowels by peculiarities in the 
shape of the resonating cavities above, mouth, pharynx and 
nasal cavities. In the case of consonants the vibrations are 
modified by a more or less complete interference with the 
outgoing flow of air. 

What would be the effect on the saliva and on digestion 
if Stenson's duct should be divided? 

If Stenson's duct should be divided, the other parotid 
would probably hypertrophy somewhat to make up for the 



PHYSIOLOGY. 91 

loss of secretion. There would be comparatively little effect 
on the saliva or digestion. At first mixed saliva would possi- 
bly be less watery and the digestion of starch somewhat 
retarded. 

Describe the physiologic aspect of atavism. 

Atavism is the peculiarity of the offspring of taking on 
the characteristics of the parent. 

Certain characteristics, inherent in the ovum and spermato- 
zoon and derived from the parents^ cause special develop- 
ment in the certain lines, thus causing the offspring to take 
on peculiarities of the parents. 

Give the extremes of slowness and rapidity of the heart's 
action which are consistent with physical vigor, and with 
ability to perform manual labor. 

The extremes would probably be from fifty to a hundred 
beats per minute ; nevertheless, no definite extremes can 
be given. 

Give the process of regeneration of uterine mucous 
membrane following pregnancy. 

Following pregnancy the mucous membrane of the uterus 
is regenerated from the epithelium of the deep glandular 
layer. Around the mouth of the glands proliferation goes on 
rapidly, the groups of new cells spreading out and finally 
coalescing with each other. About the end of the fifth week 
this new membrane is complete. All cells and shreds of 
decidual tissue not concerned undergo fatty degeneration 
and are thrown off through the lochial discharge. 

In what manner, physiologically, does a largely dis= 
tended stomach produce death? 

A largely distended stomach may cause death by interfer- 
ence with normal digestion, causing excessive fermentation 
and auto-intoxication. Or, pressure on the surrounding or- 
gans causes interference with the circulation and the func- 
tions of the organs. The venous stasis causes hypertrophy 



92 



PHYSIOLOGY. 



and dilatation of the heart, which finally gives out, death 
ensuing. 

Give the physiological properties of the facial nerve. 

The facial nerve is the motor nerve for the muscles of 
expression of the face. 

Describe hemoglobin and mention its derivatives. 

Hemoglobin is a proteid-like body, readily crystallizaJble and 
containing iron. It readily unites with oxygen and other 
gases and has a peculiar spectrum. On the addition of an 
acid or alkali, it is broken up into hematin and globin, a pro- 
teid of the globulin group. 

Hematin, hematoidin, hemin, hematoporphyrin and methe- 
moglobin are derivatives of hemoglobin. 

Define and give the physiologic significance of (a) dys= 
pnoea, (b) dysphagia, (c) apnoea. 

Dyspnoea, or difficult rapid breathing, is caused by a de- 
ficient supply of oxygen to the tissues. 

Dysphagia, or difficult or painful deglutition, may be 
caused by obstruction in the esophagus, reflex spasm, or by 
painful affections of the pharynx. 

Apnoea, or cessation of breathing, is caused by the blood 
being overcharged with oxygen, or by a reflex inhibition of 
the respiratory center. 

What prevents digestion of the stomach by its own 
juices? 

The reason that the stomach is not digested by its own 
juices is not known, so it is said to be due to a vital act. 
Neither the alkalinity of the mucous membrane, nor the 
alkalinity of the blood will explain it. 

Give the physiology of (a) blushing, (b) pallor, (c) tear 
shedding. 

Blushing is a reflex dilatation of the bloodvessels of the 
skin. Some emotional disturbance so stimulates the vasodi- 



PHYSIOLOGY. 93 

lator center in the medulla as to cause a vasodilatation of the 
skin vessels. 

Pallor is a reflex vasoconstriction of the bloodvessels of 
the skin. It is caused by a reflex excitation of the vaso- 
constrictor center in the medulla. 

Certain emotions so reflexly stimulate the lachrymal glands 
through the central nervous system as to cause tihe glands 
to secrete more fluid than can be carried off through the 
nasal duct. The excess runs over the cheeks and is called 
tears. 

What causes (a) circulation of the blood, (b) the beat= 
ing of the pulse? 

The circulation of the blood is caused by the action of the 
heart, aided by the vasomotor system. 

The beating of the pulse is caused by the transmission of 
the cardiac impulse through the elastic arterial system. 

What are the functions of the pancreas? 

The pancreas secretes the pancreatic juice. In addition 
to this, it has an internal secretion, because extirpation of 
the pancreas causes diabetes. • 

What substances are absorbed principally in (a) the 
stomach, (b) the duodenum? 

Alcohol, water and soluble salts are absorbed in large 
quantities by the stomach. The fats, proteids and glucose 
are absorbed in the duodenum and in the rest of the small 
intestines. 

Describe the conditions within normal physiological 
limits which increase arterial blood pressure. 

Anything that will directly or indirectly cause stimulation 
of the vasomotor center will cause an increase in arterial 
pressure. 

Among these causes we have digestion, muscular exercise, 
various emotions, as fear and joy, increased resistance in the 
capillary system, dyspnoea and asphyxia. 



94 PHYSIOLOGY. 

Name the inorganic proximate principles that enter into 
the formation of the human body. 

The inorganic proximate principles entering into the for- 
mation of the human body are water and the various salts, 
as sodium chloride, potassium sulphate, calcium fluoride and 
magnesium phosphate. 

What do you understand by the term nutrition, and 
what processes are comprised under it? 

By nutrition is meant the taking-in of nutrient material, 
its conversion into living protoplasm, and the throwing-off 
of waste matter from the cell. 

It includes digestion, absorption, metabolism and excretion. 

What are the Wolffian bodies? When do they appear 
and into what organs do they ultimately develop? 

The Wolffian bodies are the temporary kidneys of early 
intra-uterine life, appearing about the third week. In the' 
female they become the parovarium; and in the male, form 
the globus major, vas efferentia and coni vasculosi. 

What is the composition of human milk? 

Milk contains 112 parts of solid matter to the thousand. 
Of these, sixty parts are the carbohydrate, lactose; thirty 
are fats, olein, palmitin, stearin and butyrin; twenty are 
proteids, caseinogen, lactalbumin and lacglobulin; and two 
parts are salts, especially sodium chloride and calcium phos- 
phate. 

What are the uses of perspiration? 

, Through the perspiration we get rid of certain waste pro- 
ducts, supplementing somewhat the action of the kidneys. 
Through it we also throw off large quantities of heat. It also 
keeps the skin moist. 

What conditions increase the amount of solids in the 
urine? 

•Increased ingestion of salts will increase the amount of 
salts excreted. 



PHYSIOLOGY. 95 

Diarrhoea, free perspiration and limiting the ingestion of 
fluids, will cause a relative increase of solids. Excessive 
muscular exercise will also cause a small increase in the 
amount of solids. 

What are the functions of the pneumogastric nerve? 

Among its many functions the pneumogastric is motor and 
sensory to the larynx, motor to the pharynx and oesophagus, 
motor, sensory and secretory to the stomach, inhibitory of the 
heart, motor and sensory to the lungs, and sends more fila- 
ments through the sympathetic system to the pancreas, liver- 
and intestines. 

How are the sensations of color produced? 

According to the Yung-Helmholtz theory there are three 
sets of retinal fibers, each responding to the stimulation of 
one of the primary colors, green, red and violet. Stimula- 
tion of these in different degrees causes the various shades. 

According to the Hering theory there is one set of fibers, 
while there are three chemical substances found in visual 
purple. The anabolism of these causes white, red and yellow ; 
katabolism, black, green and blue. Various combinations; 
cause various shades. 

Describe the portal circulation; the renal circulation. 

The blood collected from the capillaries of the - spleen, 
stomach and intestines by the splenic, gastric, inferior and 
superior mesenteric veins is carried by the portal vein to 
the liver. Here this vein breaks up into smaller vessels 
running between the lobules, called the interlobular vessels. 
These break into a set of capillaries, called the lobular capil- 
laries, which coalesce to form the intralobular veins. These 
empty into the sublobular veins, which in turn form the 
hepatic vein which carries the blood into the inferior vena 
cava. The hepatic artery supplies especially the capsule of 
the liver. 

In the kidneys we find three sets of capillaries. One 



96 PHYSIOLOGY. 

set is that of the vasa recta, short vessels given off from the 
arterial trunks and supplying the medullary portion. Then 
we have the arteries of the cortex forming the set of capil- 
laries of the glomeruli. The vessels passing out from the 
glomeruli are called the efferent vessels, and again break 
up into a set of capillaries around the convoluted portion of 
the tubules. The blood is then collected by the renal venules 
and passes out through the renal vein. 

What circumstances and conditions favor gastric diges= 
tion? 

Among the many circumstances favoring gastric digestion 
are thorough mastication, slow eating, pleasant taste to the 
food, swallowing in small mouthfuls, normal amount of con- 
diments, muscular and mental quietude, and a general healthy 
condition of the various parts of the body. 

Describe the physiology of vomiting. 

Vomiting is the spasmodic rejection of the contents of the 
stomach. It may occur from an abnormal condition of the 
vomiting center in the medulla, or reflexly from the irrita- 
tion of many nerves, as the glossopharyngeal in the posterior 
surface of the larynx, or the pneumogastric in the stomach, 
or from the sight of disgusting objects, disgusting tastes or 
smells, or from irritation of other mucous membranes, as the 
uterus. 

During the act of vomiting the diaphragm is fixed, the 
cardiac orifice of the stomach is opened by the longitudinal 
fibers and the abdominal muscles contract, causing the con- 
tents of stomach to be forced into the mouth. 

What would be the effect on digestion if the pancreatic 
duct were obstructed? 

As the pancreatic secretion acts on all classes of food, there 
would be a marked decrease in the whole digestive function, 
especially on the fats and proteids. 



PHYSIOLOGY. 97 

Discuss bacteria in the intestines. 

The bacteria found in the intestines may be divided into 
three groups, — fermentative, chromogenic and pathogenic. 

The first class is very useful, forming peptones, dextrose 
and fatty acids, and breaking up some poisonous principles, 
as choline, into simpler bodies. Unless putrefaction becomes 
excessive, it is perfectly normal. 

Among other substances formed during microbic diges- 
tion are indol, skatol, phenol, carbon dioxide, leucin, tyrosin, 
hydrogen sulphide and ammonia. 

Give the relative activity of absorption in the alimen= 
tary canal, the skin and the lungs. 

The relative activity of absorption is first through the 
lungs, then through the alimentary canal, and third through 
the skin. 

Give the process of replacement of temporary by per= 
manent teeth. 

As the jaws grow and can accommodate the larger per- 
manent teeth, the little immature permanent teeth budded 
off from the temporary set begin to grow upward. As they 
grow, the fangs of the temporary teeth are gradually ab- 
sorbed, the crown falls off, and then the permanent erupt. 

What conditions retard, suspend or prevent the coagu- 
lation of blood? 

The conditions retarding, suspending or preventing coagu- 
lation are — addition of oxalates, proteoses, peptones or leech 
extract; low temperature; contact with living vascular Avails; 
the covering of the surface with oil; addition of large quan- 
tities of neutral salts ; excess of carbon dioxide ; death by 
lightning; and the diseased condition, hemophilia. 

What is the function of the superior laryngeal nerves? 

The superior laryngeal nerves are the motor for the crico- 
thyroid muscles and the sensory for the larynx. 

7 



98 PHYSIOLOGY. 

Discuss the effect of the cooking of food as a means of 
rendering it more digestible. 

It is especially on the starchy foods that cooking has a 
good effect 'by breaking up the cellulose covering of the starch 
granules and changing some of the starch into dextrin. 

The fats in the cells are also liberated. 

Upon the proteMs cooking has rather a detrimental effect, 
especially if the temperature is raised very high. For in- 
stance, the uncooked egg albumin is more readily digested 
than the coagulated cooked albumin. 

What agencies induce the flow of lymph to the point 
of discharge in the veins? 

The now of lymph is induced by the vis a tergo or pressure 
in the tissues, by muscular action and the play of the numer- 
ous lymphatic valves, by muscular tissue in the lymphatic 
vessels, and by thoracic suction. 

Name some of the involuntary muscles and the function 
with which each is concerned. 

The uterus is the organ for the carrying of the developing 
embryo and foetus. The muscle is used for the expulsion of 
the foetus at the end of intra-uterine life. 

The muscular wall of the intestine is used for mixing and 
passing on downward the food received from the stomach. 

The tunica media of the arteries contains many muscular 
fibers that control the supply of blood to the various parts 
of the body. 

What do you understand by blood pressure? 

Blood pressure is the pressure to which the blood is sub- 
jected in the circulatory system. In man it is about 110 
millimeters of mercury. 

What effect does an excessive starchy diet produce? 

It produces excessive flatulency and may lead to an ali- 
mentary glycosuria. 






PHYSIOLOGY. 99 

Give the mechanism of the organs of hearing. 

The sound waves are converged 'by the auricle, pass through 
the external auditory meatus, striking then against the mem- 
brana tympani, which sets into movement the ossicles, malleus, 
incus and stapes. The base of the stapes fits into the oval 
window. Thus the sound waves cause a movement of the 
ossicles, which in turn, through the base of the stapes, cause 
vibrations to be set up in the perilymph of the vestibule ; then 
they are conveyed through the scala vestibuli and through 
the helicotrema to the perilymph of the scala tympani, and 
out through the round window to be dispersed. 

The vibration of the perilymph in the cochlea sets up 
vibration in the scala media costaining the organs of Corti, 
which are the special receptive apparatus of hearing. 

The impressions received here are carried by the cochlear 
branch of the auditory nerve to the cerebrum. 

What is meant by digestion? 

The nutrient material or food ingested has to be so changed 
that it can be absorbed. This changing of the food is called 
digestion. 

What influence has the nervous system on the process 
of secretion? 

The nervous system controls the process of secretion by 
the various secretory centers and nerves, and by controlling 
the amount of blood to the various organs of the body. 

Name the refracting media of the eye and the effect that 
each has on the rays of light. 

The refracting media of the eye are the cornea, aqueous 
humor, crystalline lens, and the vitreous humor. 

They all converge the rays of light, the cornea being the 
most potent, the crystalline lens coming next, then the vitreous 
and finally the aqueous humor. 

What is the location of the center for articulate speech? 

The center for articulate speech is in Broca's convolution, 
the left lower frontal in right-handed people. 



100 PHYSIOLOGY. 

How is the sensation of pain produced? 

Stimulation of the special endings of the pain nerves in 
the skin, or stimulation of the trunk of the nerve, causes an 
impression to be sent to the special area of the brain pre- 
siding over pain sensations. When this center is so stimu- 
lated we feel pain. 

What kinds of food would you recommend in cases of 
obesity? 

The whole diet including water should be restricted and 
the relative amount of proteids greatly increased in cases 
of obesity. 

Give the reactions of the following fluids and state the 
cause of the reaction in each case: blood, gastric juice 
and pancreatic juice. 

Blood is alkaline from its contained alkaline phosphates 
and carbonates. 

Gastric juice is acid from the hydrochloric acid in it. 

Pancreatic juice is alkaline from the sodium carbonate it 
contains. 

Do variations in the rate and force of respiration affect 
the heart, and if so, in what manner? 

Increase in the rate and force of respiration increases the 
number and force of the heart-beats. A deep inspiration 
held for some time will reduce the rate of a rapid heart. 

Name the organs of the special senses. 

The organs of special sense are the eye, ear, upper por- 
tion of nasal cavity, the taste bulbs on the tongue, and the 
tactile end organs. 

Describe the functions of spinal nerves. 

The spinal nerves carry the afferent and efferent impulses 
of the body and of the back of head to and from the central 
nervous system. 

Among the afferent impulses we have those of pain, tem- 
perature, tactile, pressure and muscular sense. 



PHYSIOLOGY. 101 

Among the efferent, we have the motor, trophic, secretory 
and vasomotor. 

Describe the effect of a transverse section of the spinal 
cord in the mid=dorsal region. 

A transverse dorsal section would cause paralysis of mo- 
tion and of sensation of the parts below the section, paralysis 
of bladder and rectum, and exaggerated reflexes of the legs. 

What is meant by the condition of tetanus in a muscle? 

When a muscle goes into a state of continued contraction, 
it is said to be tetanized. 

Describe the digestion in the stomach of a meal of bread 
and milk. 

The ptyalin of saliva continues for some time in the stomach 
to change the starch of the bread into maltose. The hydro- 
chloric acid also has some action on the starch. The gluten 
of the bread is changed by pepsin into gluten peptone. The 
caseinogen is changed into casein by the rennin, and then 
the pepsin changes it into casein proteose and peptone. 

The lactalbumin and globulin are also changed into pro- 
teoses and peptones. The soluble salts are dissolved and the 
fats melted. 

What variations of temperature are found in the differ= 
ent parts of the body? Mention the reasons for such 
variations. 

The highest temperature is found in the blood leaving the 
liver, and is due to the amount of heat formed in this large 
gland. 

The tip of the nose is said to be the coldest part of the 
body, due to its exposed position and to the thinness of its 
walls. 

The skin surface is always cooler than the internal or- 
gans, due to the radiation of the heat of the blood from the 
skin, the evaporation of sweat from the skin and the in- 
creased amount of heat produced in the internal organs. 



102 PHYSIOLOGY. 

Describe the mechanism in the opening and closing of 
the aortic valve. 

The three leaflets of the aortic valve are placed with their 
concavity toward the aorta. During systole the pressure in 
the ventricles forces the blood past the aortic valve into the 
aorta. As the ventricle begins to dilate in diastole the pres- 
sure of the blood in the aorta tends to force the blood back 
into the ventricle. This, force fills up the pockets of the 
aortic leaflets and forces their free edges together, thus 
closing the orifice. 

Define life and death. 

"Life is that obscure principle whereby organized beings 
are peculiarly endowed with certain powers and functions 
not associated with inorganic matter." 

"Death is the cessation of life." (Dorland). 

Describe the physiology of rectal feeding. 

Small quantities of food, especially if predigested, when 
placed in the rectum are readily absorbed and will sustain 
life as long as the rectum does not become so irritable as not 
to retain tihe food. The food should preferably be predi- 
gested, but even egg albumin can be absorbed. 

What tests should be applied to ascertain the integrity 
of (a) the superficial reflexes, (b) the deep reflexes? 

To ascertain the integrity of superficial reflexes we have 
the plantar reflex or movement of the toes on stroking the 
sole of the foot; the cremasteric, the retraction of testicle on 
gently stroking the inside of the thigh; the epigastric, con- 
traction of abdominal muscles on stroking the side of the 
abdomen; the ciliospinal, dilatation of the pupil on pinching 
the skin ; and many others. 

Of the deep reflexes, the knee jerk is the one usually sought 
after. On tapping the tendon below the patella the quadri- 
ceps is thrown into action. We also have a bicipital reflex 
or contraction of biceps on tapping the tendon at the elbow. 



PHYSIOLOGY. 103 

What would be the effect of a transverse section of 
(a) the anterior root of a spinal nerve, (b) the posterior 
root of a spinal nerve? 

Transverse section of the anterior root would cause motor 
paralysis of the muscles it supplied, and finally atrophy of 
the muscles. 

Transverse section of the posterior root would cause loss 
of sensation of the part it supplied. 

Describe the physical properties of (a) lymph, (b) chyle. 

Lymph is a yellowish, salty, albuminous liquid, with a 
specific gravity of 1015. On exposure to air it clots and 
coagulates on heating. 

Chyle is simply lymph plus the minute globules of absorbed 
fat, and is milky white in color. 

How does impairment of the function of one of the fol= 
lowing affect the other two: (a) the skin, (b) the lungs, 
(c) the kidneys. 

Impairment of the function of the kidneys causes increased 
activity of the skin; and at times dyspnoea, asthmatic at- 
tacks, urinous breath, Cheyne-Stokes breathing, and con- 
gestion of lungs. 

Describe an epithelial secreting surface. 

The mucous membrane of the stomach consists of a layer 
of columnar epithelium resting on a layer of loose connective 
tissue, containing some involuntary muscular fibers and many 
small blood vessels and lymphatics. Dipping down from 
tlhe epithelial layer are numerous small glands. These glands 
are lined with cubical epithelium and secrete the gastric juice. 

In the glands of the cardiac end and of the fundus, beside 
the cubical cells, we also find along the sides a number of 
spheroidal cells. These are the cells that form the hydro- 
chloric acid. 



104 PHYSIOLOGY. 

Discuss the action of the gastric juice on carbohydrates 
and fats. 

The gastric juice has no effect on fats, except to melt some 
of them because of its temperature. 

As to the carbohydrates starch is unaffected, but the hy- 
drochloric acid possibly inverts some of the cane sugar 
present in the food. 

Give the composition and uses of blood. 

The blood is composed of 60 parts plasma and 40 parts 
corpuscles. 

In a thousand parts of plasma ninety-eight are solid. The 
bulk of the solid matter is composed of the proteids, serum 
albumin, serum globulin and fibrinogen. Besides these we 
have various salts, especially compounds of sodium, calcium, 
potassium and magnesium in combination with chlorine, phos- 
phorus and carbon dioxide. There are also fats, urea, uric 
acid, dextrose and cholesterin. 

The red corpuscles are composed of water 69%, hemoglobin 
29%, and small quantities of other proteids, salts and ex- 
tractives. 

The white corpuscles contain globulin, albumin, nuclein, 
various salts and the mother body of fibrin ferment. 

The blood carries the absorbed food and oxygen to the 
tissues and carries away waste to the organs excreting them. 
It also equalizes the temperature of the various parts of the 
body. 

Describe the process of absorption by (a) the blood= 
vessels, (b) the lymphatics. 

The digested food is carried through the columnar epithe- 
lium of the intestinal villi by the force of osmosis and the 
vital activity of the cells, the peptones being changed during 
their passage into albumins and globulins. The carbohy- 
drates, soluble salts and proteids pass into the capillaries 
and then ion into the portal vein, which carries them to the 
liver. From here they pass out through the hepatic vein into 



PHYSIOLOGY. 105 

the general circulation. The fats are taken up by the lacteals 
and carried to the receptaculum chyM and then up through 
the thoracic duct into the left subclavian vein. 

Describe the red blood corpuscles. Give the best known 
and most important function of the red blood corpuscles. 

The red corpuscles are non-nucleated, elastic, biconcave 
discs about one thirty-two hundredth of an inch in diameter. 
They are yellowish- green when seen under the microscope. 
In large masses they are red. They carry the oxygen to the 
tissues. They consist of a stroma in which is imbedded the 
hemoglobin. 

Describe the structure of the arteries. How do arteries 
exercise their function? 

The arteries have three coats — tunica intima, media and 
adventitia. The intima or internal coat consists of a lining 
of a single layer of endothelial cells and a layer of yellow 
elastic tissue. The media or middle coat is composed es- 
pecially of involuntary muscular fibers arranged transversely 
to the long axis, but it also contains many elastic fibers. The 
adventitia or outer coat is made up of a supporting layer of 
areolar tissue in which are many yellow elastic fibers. 

In the media we find many little ganglionic masses, the 
local vasomotor system. In these the vasomotor nerves end. 

The arteries exercise their function on account of being 
closed tubes, by reason of their contained elastic tissue, and 
by the action of the vasomotor influence of the nervous sys- 
tem on the muscular fibers. 

Describe the fetal circulation. 

The blood coming from the placenta through the umbilical 
vein passes into the inferior vena cava, some of it passing 
first into the liver by the ductus venosus and then into the 
inferior vena cava. It is then carried into the right auricle, 
where it meets the blood returning by the superior vena cava 
from the head and upper extremities. 

The currents do not mix to any extent, but by means of the 



106 



PHYSIOLOGY. 



Eustachian valve the blood from the inferior vena cava flows 
through the foramen ovale into the left auricle, where it 
meets the small amount of blood coming from the lungs and 
is passed on into the left ventricle and out through the aorta 
to supply especially the head and arms. 

The blood from the superior vena cava passes through the 
right auricle into the right ventricle and then out through 
the pulmonary artery. Some of this blood passes to the 
lungs, but most of it passes through the ductus arteriosus into 
the descending aorta, where it mixes with the blood from the 
left ventricle and supplies the lower extremities, a portion 
passing through the umbilical arteries to the placenta. 

Mention the erectile tissues of the body and explain 
their function. 

The erectile tissues of the body are the penis, clitoris, 
nipples, and according to some, the mucous membrane of 
nose. They are concerned in the genital sense, increasing the 
sexual excitement and helping 'complete orgasm. 

What digestive changes take place in (a) the small in= 
testines, (b) the large intestines? 

In the small intestines proteids are changed into peptones 
and even (Lower bodies, as arginin and leucin; fats are split 
up, saponified and emulsified; undigested starch is changed 
into maltose, which in turn is changed into dextrose, and cane 
sugar is inverted. 

In the lower part of the small intestine and in the large 
intestine microbic digestion is carried on with the forma- 
tion of putrefaction products, carbon dioxide, methane, 
hydrogen sulphide, hydrogen, indol, skatol, phenol, butyric 
acid, valerianic acid, leucin, tyrosin, trimethylamine, and 
many other products. 

Describe the structure of (a) striated muscle, (b) non= 
striated muscle. Which of these is called voluntary, and 
why? 

Striated muscle is composed of fibers transversely striated. 



PHYSIOLOGY. 107 

Each fiber is about one inch long and one five-hundredth of 
an inch in diameter. 

The fibers consist of an outside sheath or sarcolemina, which 
is filled with a liquid, the sarcoplasm. Imbedded in this we 
find the muscle columns or sarcostyles. These are divided by 
a Kraus membrane into sarcomeres, each of which is com- 
posed of a central dark portion, the sarcous element, and on 
either side a lighter portion. 

Non-striated muscle is formed of small spindle-shaped 
nucleated cells, not transversely striated. It has some faint 
longitudinal striations. 

Striated muscle is voluntary, that is, under the control of 
the will. 

Define reflex nervous action. Give examples. 

A reflex action is an afferent impulse followed by an ef- 
ferent impulse independent of the higher cerebral centers. 
A blow in the solar plexus causes an inhibition of the heart. 
The testicle retracts when the inner surface of thigh is stroked. 

Describe the rods and cones of the retina. 

The layer of rods and cones of the retina is the ninth and 
is separated from the choroid by the tenth or pigment layer. 
The rods are more abundant than the cones, about five to one, 
but are absent in the fovea centralis, the cones only being 
present. In the outer end of the rods the visual purple is 
found. The cones are shorter than the rods and contain 
no visual purple. The optic nerve ends in these rods and 
cones, which are the active receptive organs of sight. 

Describe the sphygmograph and state its use. 

The sphygmograph or pulse recorder essentially consists of 
a spring fastened at one end, with a button on the other 
end to press on the artery, and a system of fine levers so ad- 
justed as to write the movements of the spring on strips of 
glazed, blackened paper. 



108 PHYSIOLOGY. 

How is accommodation in the eye accomplished? 

Accommodation is accomplished by the contraction of the 
ciliary muscle relaxing the suspensory ligament and thus al- 
lowing the crystalline lens to become more convex, which it 
then docs on account of its elastic capsule. 

How do veins, arteries and capillaries differ as to (a) 
structure, (b) function? 

The arteries have three coats, which contain more muscular 
and elastic tissue than the veins. The arteries have no 
valves, while many of the veins have. The capillaries are 
formed of a single layer of lance-shaped endothelial cells. 

The arteries carry the blood from the heart to the capil- 
laries. The veins carry it back to the heart. Through the 
capillary wall osmosis and diapedesis occur; thus the tissues 
are nourished and the waste matter is carried off. 

What is the function of each class of foods in the nutri= 
tive process? 

The proteids repair the tissue; the carbohydrates are the 
body fuel, being easily oxidized; the fats are not so readily 
oxidized but are used up to form heat, the excess being stored 
in the adipose tissue; the salts are necessary to keep some 
of the proteids in solution, to regulate osmosis, to neutralize 
the acid produced by katabolism, to form bone, and are a 
necessary ingredient in most of the secretions. 

State the origin and the uses of (a) lymph, (b) the bile. 

Lymph is' the diluted blood plasma that has osmosed through 
the capillary wall, to which is added lymphocytes formed in 
the lymphatic glands. It bathes and nourishes the tissues, 
carries away waste and adds lymphocytes to the blood. The 
products of some of the ductless glands are emptied into it. 

The bile is formed in the liver. Bile neutralizes the acid 
chyme, precipitating the pepsin, aids in the emulsiflcation and 
absorption of fats, increases peristalsis, and contains some 
waste products. 



PHYSIOLOGY. 109 

In what manner is the heartbeat influenced by the 
pneumogastric nerve? What is the average number of 
heartbeats per minute in (a) a child aged one year, (b) 
an adult aged seventy years? 

Stimulation of the pneumogastric nerve causes a slowing 
of the heart. 

The average number of heart-heats at one year of age is 
about 115; at seventy years of age, about 70. 

Define emulsification, saponification. Illustrate. 

Emulsification is the breaking up of a fat into very small 
particles and holding them in suspension in a liquid in which 
they will not dissolve, as shaking together bile, w T ater, and 
olive oil. 

Saponification is the replacing of the glycerin of a fat by 
an alkali, as by the heating together of olein and sodium 
hydrate (to form sodium oleate and glycerin. 

What causes an increased flow of bile into the duo= 
denum? What pathologic effects may ensue because of 
occlusion of the ductus communis choledochus? 

The act of digestion causes an increased flow of bile into 
the duodenum, as will also certain drugs, as calomel and 
podophyllin, and irritation of the intestinal mucous mem- 
brane. 

Occlusion of the ductus communis choledochus is followed 
by jaundice with its tendency to malaise, headaches, anaemia 
and slowing of the heart's action. It also interferes with the 
digestion and absorption of fats, allows of an excess of putre- 
factive substances being formed in the intestines, and also 
causes constipation. 

State the function of the third cranial nerve. What is 
the effect of division of the third cranial nerve? 

The third nerve is the motor nerve for the internal rectus, 
superior rectus, inferior rectus, inferior oblique, levator palpe- 
brarum, ciliary muscle and the constrictor of the pupil. Sec- 



110 PHYSIOLOGY. 

tion of this nerve causes loss of accommodation, ptosis, ex- 
ternal or divergent squint and diplopia, 

What are the movements of the eyeball? Mention the 
muscles concerned in each of the movements. 

Protrusion — caused by the muscular fibers in the capsule 
of Tenon. 

Retraction — caused by the tight closing of the lids or para- 
lysis of the muscular fibers in the capsule of Tenon. 

Upward movement — caused by contraction of superior rec- 
tus and inferior oblique. 

Downward movement — caused by contraction of inferior 
rectus and superior oblique. 

Inward movement — caused by contraction of internal 
rectus. 

Outward movement — caused by contraction of external 
rectus. 

Rotary movement — caused by contraction of either of the 
two oblique muscles. 

What are the accepted theories as to the origin of (a) 
the red blood corpuscles, (b) the white corpuscles? 

The red corpuscles are formed in the red marrow of bones, 
and in the spleen. 

The white corpuscles are formed in the lymphatic system, 
the spleen and the marrow of bones. 

How is the diaphragm affected in expiration? State 
cause. 

The central tendon of the diaphragm is drawn upward into 
the thorax during expiration by elastic recoil of the lungs, 
tending to produce a vacuum in the pleural cavity. 

Define secretion, excretion, protoplasm, assimilation. 

A secretion is that product of glandular activity needed 
in the various processes of the living organism. 

An excretion is that product of glandular activity con- 
taining waste of no further use to the organism. 



PHYSIOLOGY. Ill 

Protoplasm is the living substance surrounding a specially 
formed element called the nucleus. 

Assimilation is the conversion into protoplasm of nutrient 
material or food ingested. 

What are the causes of the apex beat of the heart? 

The apex being free it is brought forward to strike against, 
the chest wall by the contraction of the ventricle. The shock 
of the contracting muscle also contributes to it. 

What special use does each of the following serve in the 
body after ingestion: proteids, fats, carbohydrates, alco= 
hoi, tea, and coffee? 

Proteids repair the tissues, fats are used for body fuel and 
as a reserve, carbohydrates are the body fuel, alcohol in 
small doses is a general stimulant and by irritating the 
mucous membrane causes an increased flow of gastric juice. 
Tea and coffee are stimulants, increasing the flow of the 
various secretions and stimulating peristalsis. 

State the functions of the fifth cranial nerve. 

The fifth nerve is the sensory nerve of the face, mouth 
and nasal cavities, and the motor nerve of the muscles of 
mastication. 

What effect, if any, results from the division of (a) a 
vasoconstrictor nerve, (b) a vasodilator nerve? 

Division of a vasoconstrictor nerve causes a vasodilation 
in the part it supplies. 

Division of a vasodilator nerve usually has no effect. If 
it be in action at the time, a vasoconstriction would follow. 

Describe the vermicular movement of the stomach and 
intestines. What purpose does this movement serve? 

The movement of the stomach causes the food there to be 
thoroughly mixed, the peculiar contraction causing a current 
down along the fundus to the pylorus and back again along 
the lesser curvative. 



112 PHYSIOLOGY. 

The movement of the intestine is a true peristaltic one, that 
is, one segment of the intestinal walls contracts after the 
preceding segments ; thus a wave of contraction passes down, 
mixing and pressing the food on downward. 

Differentiate white fibrous tissue and yellow elastic 
tissue as to (a) structure, (b) distribution. 

White fibrous tissue consists of white fibers arranged in 
parallel bundles, the connective tissue cells also being ar- 
ranged in this way. Yellow elastic tissue is a connective 
tissue in which the yellow fibers predominate. These fibers 
are larger than the white and are bound together with areolar 
tissue. The white fibrous tissue is found where strength and 
inelasticity is needed, as in the ligaments and tendons. 

The yellow fibrous tissue is found where elasticity is 
needed, as in the coats of the blood vessels, in the lungs, and 
vocal cords. 

Explain the action of the anospinal center in defecation. 

The anospinal center is the reflex center for defecation. 
Irritation of the mucous membrane of the rectum sends an 
impression to the anospinal center, which then causes a re- 
laxation of the sphincter muscles and an increase in peris- 
talsis. This center is under the control of the will to a great 
extent. 

How is the venous blood current maintained? What 
arteries carry venous blood? 

The venous flow is maintained by the vis a tergo, or force 
of the heart carried through the capillaries, by the play of 
the valves in the veins during muscular movements, and by 
thoracic and intracardiac action. The pulmonary arteries 
carry venous blood. 

What causes the difference in pitch between male and 
female voices? What causes the voice of the youth at 
the period of puberty to " crack "? 

The male vocal cords are longer, hence the lower pitched 
voice. 



PHYSIOLOGY. 113 

The cause of the cracking of voice at puberty is the change 
from the childish treble to the lower adult voice, causing 
now and then a treble tone to be put in. 

What is the function of connective tissue? 

The connective tissue acts as a binding, supporting, con- 
necting and protecting tissue for the more delicate tissues 
and organs. 

What is (a) an efferent nerve, (b) an afferent nerve? 
Illustrate. 

An efferent nerve is one carrying impulses from the cen- 
tral nervous system to the various parts of the body. The 
facial nerve carries motor impulses from the central nervous 
system to the muscles of expression. 

An afferent nerve is one carrying impulses to the central 
nervous system from the various parts of the body. The 
optic nerve carries impressions received on the retina to the 
brain. 

Describe the glands and villi of the intestines. 

In the intestines we find two sets of glands, Brunner's 
and Lieberkuhn 's. 

The glands of Brunner are branched convoluted tubular 
glands found dipping down in the mucous membrane of the 
duodenum only. 

The crypts of Lieberkuhn are little tubular depressions in 
the mucous membrane of both the small and large intestines. 
They are larger in the large intestine. They consist of a 
basement membrane lined with columnar and goblet-shaped 
epithelial cells. 

The villi are small nipple-like projections from the mucous 
membrane of the small intestines about one- thirtieth of an 
inch long. 

A villus consists of a mass of adenoid tissue covered with 
a layer of columnar epithelium resting on a basement mem- 
brane. In the center of this adenoid tissue we find a little 



114 PHYSIOLOGY. 

lymphatic called a lacteal. We also find in the adenoid tissue 
many capillaries which coalesce to form the venules of the 
mesenteric veins. 

Describe the movements of the blood corpuscles in the 
capillaries and explain the phenomena of diapedesis. 

The capillaries are on an average just large enough to al- 
low the red corpuscles to pass through. In passing through 
some of the capillaries they are altered somewhat in shape, 
but on account of their elastic stroma immediately resume 
their shape when the pressure is removed. As they have to 
flow along in single file at juncture of two capillaries to form 
one, they take alternate turns in passing into it. 

The white corpuscles tend to adhere! to the wall and do 
not move as rapidly as the red ones. 

In diapedesis the white corpuscle pushes one of its pseu- 
dopodia through the cement substance of the cells of the 
capillary wall, and then pulls the rest of the body through 
after it. 

Mention three varieties of cells according to situation 
in the body. 

Epithelial cells are found in the skin. 

White blood corpuscles are found in the blood. 

Nerve cells are found in the central nervous system. 

What is the mode of production of heat in the body? 

Heat is produced by the chemical action going on in the 
tissues, especially in the muscular and glandular tissues. 

Describe cholesterin, giving its origin and function. 

Cholesterin is a monatomic alcohol found especially in the 
nervous tissue, and thrown off in small quantities from the 
body in bile. It is possibly a waste product of the nervous 
tissue. 

Mention and describe three varieties of cells according 
to shape. 

Involuntary muscular fibers are small spindle-shaped cells, 



PHYSIOLOGY. 115 

containing about their center an oval nucleus. They are 
faintly longitudinally striated. 

Squamous epithelial cells are flat scale-like cells, having 
a small nucleus near their center. 

White blood corpuscles are nucleated granular masses of 
protoplasm, about one twenty-five-hundredth of an inch in 
diameter. At rest they are globular, but during ameboid 
movement are irregular in shape. 

Mention the ductless glands and give the theory as to 
the function of any one of them. 

The ductless glands are the thyroid, thymus, adrenals, 
spleen, pituitary body, coccygeal and carotid. Many other 
organs have also internal secretion. 

The adrenal secretion has a marked influence over vaso- 
motor and general muscular tone. 

How is the sensation of sound conveyed to the brain? 

It is conveyed from the cochlea by the auditory nerve to 
the medulla, then to the superior olive, through lateral fillet 
to the posterior quadrigeminal bodies to the cerebral cortex. 

What matters are excreted by the skin? How may the 
function of the skin be affected as to the amount of ex= 
cretion? 

The sweat contains one per cent, of solid matter, in which 
we find sodium chloride and other inorganic salts, urea, fatty 
acids and coloring matter. 

The function of the skin may be affected physiologically 
by increased urination and diarrhoea, by reflex irritation of 
sweat centers, by the emotions, by increase of body tempera- 
ture calling for more heat dissipation, and by the accumula- 
tion of carbon dioxide in the blood. Ingestion of many drugs 
also affects the excretion. 

Mention some of the exercises that injuriously affect 
the heart. State the reasons for your conclusion. 

Among exercises that injuriously affect the heart are 



116 PHYSIOLOGY. 

wrestling, long-distance racing, bicycle racing and rowing 
matches, the bad effect being due to the sudden strain which 
causes dilatation and hypertrophy of the heart. 

State the function of the retina. 

The retina is the receptive nervous organ of sight. 

What are the physiologic characteristics of protoplasm? 

Protoplasm has the power of nutrition, growth, reproduc- 
tion, movement and response to stimuli. 

What is the usual difference in shape between the red 
corpuscles of the blood in the mammalia and those in 
the ovipara? 

With the exception of the camels, mammalian red cor- 
puscles are non-nucleated, biconcave, circular discs. In the 
ovipara they are nucleated, oval and biconvex. 

State the changes in the diameter of the chest in in= 
spiration and expiration. 

In inspiration the vertical diameter is increased by the 
descent of the diaphragm; the anteroposterior and trans- 
verse diameters are increased by the raising and rotation of 
the ribs anteriorly and laterally. 

The reverse occurs during expiration. 

The circumference of the chest is increased in forced in- 
spiration from 2 to 5 or 6 inches over forced expiration. 

Explain the anatomic and physiologic difference between 
mucous, serous, and synovial membrane. 

Mucous membranes are secreting membranes lining cavities 
opening into the air and composed of one or more layers of 
epithelial cells. 

Serous membranes are those lining closed sacs belonging 
to the lymphatic system and composed of a single layer of 
flat endothelial cells on a basement membrane. 

iSynovial membranes are those lining closed sacs or bursae 
in joints or over tendons. They secrete synovia, which al- 
lows free motion by preventing friction. 



PHYSIOLOGY. 117 

Describe the physical properties of healthy urine. 

Healthy urine is a straw yellow, acid, clear liquid, with 
a specific gravity of 1015 to 1025, and with a peculiar odor. 
On standing, a slight sediment collects in the lower part of 
the liquid. 

Describe the changes in form and volume, and in physi= 
cal and chemical properties, occurring in the contraction 
of a muscle. 

The muscle becomes shorter, but the volume remains the 
same. It becomes acid in reaction, more oxygen is used up 
and more carbon dioxide given off, sarcolactic acid is gen- 
erated, giycogen is used up, and the muscle substances soluble 
in water are diminished in amount, while those soluble in 
alcohol are increased. 

Locate in the brain, the seat of the special sense of 
sight, hearing and smell. 

Sight has its seat in the gyrus angularis, cuneus, and in 
the occipital lobes; hearing in the superior temporal; smell 
in the uncus. 

Explain the phenomena and causation of auditory ver= 
tigo or Meniere's disease. 

It is due to some disturbance or abnormal irritation of the 
endings of the vestibular branch of the auditory nerve. This 
branch normally sends impressions to the nucleus fastigii in 
the cerebellum which help to control the balancing and co- 
ordination of the muscles of the bod}'. 

How do the striped and unstriped muscular fibers differ 
in response to stimuli? 

The unstriped muscular fibers are much slower in response. 

What is the order of occurrence of rigor mortis in the 
different parts of the body? 

Rigor mortis usually begins in the muscles of the eye, 



118 PHYSIOLOGY. 

passing to the jaw and neck muscles, and in turn to the 
chest, arms, abdomen and lower extremities. 

What relation does the nervous system bear to the ex= 
cretion of perspiration? 

The nervous system through the sweat centers regulates the 
excretion of perspiration. 

What portion of the cerebrum comprises the motor area? 

The motor area is found along the fissure of Rolando in 
the ascending parietal, ascending frontal and paracentral con- 
volutions and contiguous parts of the superior frontal. 

Give the presumptions of survivorship and reasons 
therefor in the following from Casper: A is killed by a 
thrust of a saber on the head; B by that of a bayonet in 
the heart; and C by a shot which has torn open the jug= 
ular vein. 

If A's injury involved especially the base of the brain the 
shock of the injury would probably cause instant death. 

B would probably be the second to die, probably living at 
least a half hour until the giving out of the heart from 
pressure of the blood in the pericardium. 

C would be the last to die, as lacerated wounds of even 
large vessels often stop spontaneously, and his bleeding might 
"be checked by pressure until surgical help arrived. 

Define the function of the mucous membrane of the 
respiratory tract. 

The mucous membrane of the respiratory tract secretes a 
protecting mucus, and because of its ciliated epithelial cells 
keeps the lungs clear of accumulation of mucus and small 
dirt particles entering in the inspired air. The vital activity 
of the squamous cells lining the air vesicles aids in the ex- 
change of the respiratory gases. 

In what glands of the body is the function undeter= 
mined? 

With the exception of being able to say that they are all 



PHYSIOLOGY. 119 

probably connected with general metabolism, the functions 
of the following glands are undetermined: Pituitary body, 
thymus, coccygeal gland. But little is known about the 
adrenals and thyroids. 

What is the normal ratio of respirations to heart pul= 
sation? 

In a healthy adult there are four pulse heats to one re- 
spiration. 

Give the foramen of exit, the distribution and the func= 
tion of the oculomotor nerve. 

The oculomotor nerve leaves the skull through sphenoidal 
fissure. It supplies motor filaments to the superior, in- 
ternal and inferior recti, the inferior oblique, the levator 
palpebrae, the ciliary muscle and the constricting fibers of 
the iris. 

What office does the Eustachian tube perform? 

It equalizes the pressure of the air on the membrana- 
tympani, thus facilitating hearing. 

Define leucomain. 

Leucomains are alkaloidal or basic substances formed in 
the living tissue by metabolism, waste in nature, some of 
them toxic. 

Give the present physiologic conclusions in respect to 
the presence of the corpus Iuteum as a sign of pregnancy. 

According to Tidy, "there may be pregnancy without the 
presence of a true corpus Iuteum, and also bodies indis- 
tinguishable from true corpora lutea may be found where 
there has been no pregnancy." The presence of the true 
corpus Iuteum nevertheless is usually a sign of pregnancy. 

What effects are produced in the system by the removal 
of the thyroid gland? 

Removal of the thyroid gland is followed by peculiar de- 
praved condition of metabolism called cachexia strumipriva. 



120 PHYSIOLOGY. 

Give the principal characteristics of gastric juice in man. 

Gastric juice is an acid limpid secretion with a specific 
gravity of about 1005, quantity ten pints daily. It contains 
especially pepsin, rennin and hydrochloric acid. 

How can fresh blood stains be distinguished from older 
blood stains? 

Fresh blood stains are brighter in color and the clot is 
flexible; the older stain is darker and the clot is fragile. 

Describe color blindness and name the colors which the 
subject commonly fails to distinguish. 

Color blindness is the inability to perceive certain colors. 
The colors commonly indistinguishable are red and green. 

What are the functions of the brain membranes? 

The dura mater is tough and protecting, and also acts as 
internal periosteum to the bones of the head. 

The arachnoid is a thin spider-like membrane covered 
with endothelial cells that secrete cerebrospinal fluid. 

The pia mater is a vascular membrane dipping down into 
the sulci and carrying blood to the cortex. 

Name the solids in the urine and state the approximate 
amount of each voided daily by an adult. 

Urea 500 grains; chloride of sodium 180 grains; sulphates 
(sodium and potassium) 30 grains; phosphate (earthy and 
alkaline) 45 grains; uric acid 7 grains; hippuric acid 7 
grains; and small quantities of various pigments and other 
organic matter. 

Describe the factors which cause the heart sounds. 

The first sound is due to muscular contraction and to the 
closure of the auriculo- ventricular valves, as the blood tends 
to regurgitate into the auricles during ventricular systole. 

The second sound is due to the closure of the semilunar 
valves, as caused by the blood tending to regurgitate into 
the ventricles during diastole. 



PHYSIOLOGY. 121 

What is the effect of an excessive meat diet? 

An excessive meat diet disturbs the general metabolism, 
causing diseased conditions associated with an increase in 
uric acid, as gout, rheumatism and migraine. 

Explain how the seminal fluid is conveyed to the vesi= 
culae seminales. 

It is conveyed to the vesiculae seminales by the vas deferens, 
which is the prolongation of the tube forming the epididymis. 
The vas deferens passes up from the testicles through the 
external and internal abdominal rings and to the vesiculae 
seminales on the posterior surface of the bladder. 

How and why is hearing affected by rupture of the 
membrana tympani? 

The membrana tympani, on account of its shape and the 
action of the tensor tympani, is capable of responding to 
many vibrations, and thus aids in the acuity of hearing. 

Describe cell growth. 

Cell growth is that peculiarity which living cells have of 
taking in new material and incorporating it into themselves, 
thus increasing in size. 

Describe the phenomena of (a) asphyxia, (b) syncope, 
(c) sleep. 

Asphyxia is the condition caused by a deficient supply of 
oxygen. In the complete shutting off of the supply of 
oxygen we have three stages. First, the stage of marked in- 
spiratory efforts or dyspnoea, lasting about one minute; 
second, the stage of convulsions with marked expiratory 
spasms, lasting about one minute ; and third, the stage of ex- 
haustion and finally death. 

During the first stage the blood pressure begins to rise and 
heart becomes somewhat slower. During the second stage 
this rise in blood pressure is well marked and also the slow- 
ing of the heart. Toward the end of this stage as the re- 
spiratory movements cease unconsciousness ensues, the blood 



122 PHYSIOLOGY. 

pressure falls and the heart 'becomes still slower, until death 
stops everything. 

Syncope is that condition of unconsciousness following a 
sudden depression of the vasomotor and cardiac nervous 
mechanism, icausing anemia of the brain. 

Sleep is a physiological condition of unconsciousness, due 
to a periodical need of the nervous system of rest. It is 
also due in part to the absence of external stimuli. It is ac- 
companied by an anemia of the brain. 

Name, locate, and give the function of each of the vari= 
eties of epithelia. 

Epithelium secretes' and protects the underlying tissues. 
Squamous epithelium, found in the mouth, protects the under- 
lying structures. Columnar epithelium, found in the intes- 
tinal mucosa, aids in the absorption of digested food products. 
Ciliated epithelium, found in the bronchial mucosa, forces 
dust and mucus up into the trachea to be coughed out. 
Cuboidal epithelium, found in the salivary glands, secretes 
saliva. Goblet-shaped epithelium, found in the mucous mem- 
branes, forms the mucous secretion. Stratified epithelium is 
composed of several layers, the uppermost generally squa- 
mous, and lowermost columnar. It forms the epidermis. 

Describe the lymphatic system. 

The lymphatic system consists of numerous small thin- 
walled vessels with many valves, commencing in the tissues 
as lymph capillaries and emptying into two large vessels 
that carry the contained lymph to the subclavian veins. In 
certain places along the course of the lymphatics, as in 
axilla and groin, are found groups of little glands called 
lymphatic glands. These consist of a cortical portion and 
a medulla which is made of lymphoid tissue, in the center of 
which are a number of cells rapidly undergoing karyokinesis. 

All the lymphatics (including the lacteals of the intestine) 
with the exception of right half of the body from the dia- 
phragm upward, empty into the thoracic duct. This vessel, 



PHYSIOLOGY. 123 

about the diameter of a goose quill, empties into the left 
subclavian vein. The lymphatics of the right side of the 
body from the diaphragm upward empty through a smaller 
vessel into the right subclavian vein. 

Describe the olfactory apparatus. What part of the 
olfactory apparatus is the seat of smell? 

The nasal cavities are divided into a lower or respiratory 
portion and an upper or olfactory portion. 

We find in the upper portion some broad supporting epithe- 
lial cells, and projecting upward from cells between these 
are little hair-like processes. The olfactory nerve ends in 
these specialized cells. The olfactory nerve passes from these 
cells through the olfactory bulbs and backward through three 
tracts to the cerebrum, ending for the most part in the uncus 
of the same side. 

What is the physiology of the so=cal!ed rest cure? 

The rest cure corrects faulty metabolism and brings the 
tissues again to their normal conditions. 

How is the descent of the testicle to the scrotum ac= 
complished? 

The descent of the testicle is now generally thought to be 
due simply to the arrangement of the organs due to the 
process of development and not to the traction of muscular 
cord, as formerly thought. 

Describe the growth and the development of the teeth. 

The first step in the formation of the teeth is the down- 
ward growth of the epithelium covering the rudimentary jaw. 
This forms the enamel germ, which develops especially at cer- 
tain points. A little vascular papilla now grows upward 
into this enamel germ; thus we have the rudimentary teeth. 
The adamantoblasts of the enamel germ form the enamel, and 
the odontoblasts form the dentine which covers in the dental 
pulp. The crusta petrosa is formed from the cells forming 
the dental periosteum. 



124 PHYSIOLOGY. 

What is the condition of the eyeball in myopia? How 
may it be corrected? 

In myopia the eyeball is too deep, causing the rays of 
light to he brought to a focus in front of the retina. It is 
corrected by a concave lens. 

Define physiologically the term cell. How are cells re= 
produced? 

A cell is a nucleated mass of protoplasm. 
Cells are reproduced by direct division, indirect division 
or kary ookinesis, and endogenous nuclear multiplication. 

Describe the physical characteristics of cartilage. What 
is temporary cartilage, permanent cartilage? Illustrate. 

Cartilage is a firm, elastic, white or yellow-White sub- 
stance. 

Temporary cartilage is that which afterward is formed 
into bone, as the fetal femur. 

Permanent cartilage is that which remains as cartilage dur- 
ing life, as articular cartilage. 

Describe the white blood corpuscles, giving source, com= 
position and properties. 

The white blood corpuscles are nucleated masses of granu- 
lar protoplasm, about -2 sV "o i n '- i n diameter and capable of 
amoeboid movement and phagocytic action. 

As to the varieties, we find the small lymphocyte, the larger 
transitional, the polymorpho-nuclear, and eosinophile con- 
taining large granules staining readily with eosin. Occas- 
ionally a basophile can be found. 

The white cells are developed from the lympatic tissues, 
the spleen and the marrow of bone. Chemically 'they con- 
tain nuclein, a globulin, fat, glycogen and a nucleoproteid. 

What changes are produced in the air and in the blood 
by respiration? 

The expired air contains less oxygen and more carbon 
dioxide, nitrogen, and water than inspired air. It also con- 



PHYSIOLOGY. 125 

tains certain volatile organic substances and is warmer than 
the inspired air. 

The blood leaving the lungs contains more oxygen and less 
carbon dioxide and nitrogen than that entering the lungs. 

Define aphonia, aphasia. Give the cause of one of these 
conditions. 

Aphonia is the loss of voice, or the power of phonation. 

Aphasia is the inability to give the proper word symbol. 

Motor aphasia is due to a lesion of the left lower frontal 
convolution or of the fibers coming from it. 

Describe the normal heart sounds. 

The first sound is twice as long as the second, lower in 
pitch and with a prolonged dull, somewhat booming quality. 
It is caused by the closure of the auriculo- ventricular valves 
and the sound of contracting muscular walls of the ventricles. 
It is heard best at the apex, and is systolic in time. 

The second sound follows the first after a short interval. 
It is short, snapping in quality and is higher pitched than 
the first. It is caused by the closure of the semilunar valves 
and is diastolic in time. It is heard best at the base of the 
heart. 

State the physiologic uses of the large intestine. 

Into the large intestine the crypts of Lieberkuhn pour in 
some secretion and the microbic digestion goes on. Although 
no villi are found here part of the food not already absorbed 
is taken up. The feces are concentrated and collected in the 
lower end of the intestine, to be expelled during the act of 
defecation. 

Define (a) tonic muscular contraction, (b) clonic mus= 
cular contraction. Give an example of each. 

Tonic muscular contraction is a continued contraction, as 
the action of sphincter and. 

Clonic muscular contraction is an intermittent or remittent 
muscular contraction as seen in the jerking movements of a 
convulsion. 



126 PHYSIOLOGY. 

Define reserve air, residual air, complemental air, tidal 
air. 

Reserve air is the amount of air that can be expired after 
an ordinary expiration, about 100 cubic inches. 

Residual air is the amount of air left in the lungs after 
the most forcible expiration, about 100 cubic inches. 

Complemental air is the amount of air that can be taken in 
after an ordinary inspiration, about 100 cubic inches. 

Tidal air is the amount of air taken in with each ordinary 
inspiration, about 30 cubic inches. 

What are the respective functions of the anterior and 
of the posterior cornua of the spinal cord? 

The anterior cornua are motor in function and are the 
trophic centers for the muscles. 

The posterior cornua are mostly relay stations on the sen- 
sory pathway. 

What explanation may be given for enlargement of the 
spleen in leucocythemia? 

The spleen is one of the organs in which white corpuscles, 
are formed. 

Give the difference between the temperature of a new= 
born child and that of an adult, between the temperature 
of a person intoxicated by alcoholic drink and his tem= 
perature after the first stimulating drink of liquor. 

Immediately after birth the temperature is somewhat above 1 
normal, but soon becomes subnormal. At the end of twenty- 
four hours it has again reached normal and remains so. A 
small dose of alcohol causes a slight rise in temperature; 
large doses, as in one intoxicated,' cause a subnormal 
temperature. 

In a healthy man, what time is consumed in the diges- 
tion of an ordinary meal of meat, vegetables and bread? 

The food remains from two to four hours in the stomach 
and about six hours in the small intestine. Digestion is. 
practically finished before it leaves the small intestine. 



PHYSIOLOGY. 127 

Define human physiology. 

Human physiology is the study of the phenomena of the 
living human body. 

Give the causes of muscular fatigue. 

Muscular fatigue is caused by the accumulation of waste 
products in the muscles. 

The seat of fatigue, as we ordinarily speak of it, is first in 
the central nervous system, then in the motor end plates,, 
then the muscle and finally the nerve trunks. 

What effect is produced on the heart's action by stimu- 
lation of the cardioinhibitory center? 

There is a slowing of the heart, or, if the stimulus is great 
enough, a stoppage of the heart in diastole. 

Why does blood remain fluid in the body in life, and 
coagulate when shed? 

The intima has some unknown peculiar action on the blood. 
The blood does not clot until the disintegration of the 
white corpuscles sets free the fibrin ferment. 

What conditions produce variations in the normal tem= 
perature of the body? 

Anything that will disturb the proper balance of heat pro- 
duction and heat dissipation will cause a variation from the 
normal temperature. 

Normal physiological variations are caused by digestion, 
muscular exercise, menstruation, bathing and excitement. 

Drugs, as cocain, atropine, alcohol, acetanilid, may cause 
variations from the normal; as will also hypodermic in- 
jections of proteoses and peptones, shock, toxins of bacteria 
and exposure to excessive changes in temperature of at- 
mosphere. 

Give the nervous mechanism of urination. 

The bladder is supplied with nerves from the lower dorsal 
and upper lumbar nerves and also with branches from the- 



128 PHYSIOLOGY. 

sympathetic system. The act of urination may he completely 
involuntary, the reflex center being in the lumbar portion 
of the spinal cord and set in action by afferent impulses 
from a distended bladder or from irritation possibly of the 
mucous membranes. Ordinarily the abdominal muscles aid 
voluntarily in urination. 

There is probably a higher voluntary center and also an 
inhibitory one. 

Describe the human blood. 

Blood is a red, alkaline fluid, salty and nauseating in taste, 
with a peculiar odor. It has a specific gravity of about 1055. 
It is composed of a liquid portion called plasma, and a solid 
portion, the red and white corpuscles. In the plasma we 
find serum albumin and globulin, fibrinogen, various salts, 
especially sodium, potassium and calcium, and small quan- 
tities of dextrose, fats and extractives. The hemoglobin is 
found in the red corpuscles. 

What is the purpose of respiration? Give the mechan= 
ism of respiration. 

During the act of respiration oxygen is absorbed and car- 
bon dioxide is thrown off. 

During inspiration the diaphragm descends, the ribs are 
elevated and rotated outward; the cavity of the thorax is 
thus enlarged and the air rushes in to fill up the partial 
vacuum ; the muscles now relax and the elasticity of the chest 
wall and lungs forces a portion of the air out. These move- 
ments are controlled by the respiration center in the medulla. 

How is bone nourished? 

Bone is nourished by the nutrient arteries through the 
Haversian system of canals and by the periosteum. 

State the function of the anterior spinal nerve roots, 
How is the function proved? 

The anterior roots are motor. 

Section of the anterior roots causes motor paralysis of 



PHYSIOLOGY. 129 

the parts that they supply. Irritation of the peripheral ends 
causes contraction of the muscles they supply. Irritation of 
central ends has no effect; no sensation is felt. 

Give illustrations of morbid reflex action. 

The vomiting; of pregnancy is caused renexly by irrita- 
tion of mucous membrane of uterus. 

Faulty digestion may cause renexly palpitation of the 
heart. 

What is the composition of urine? Give the norma! re= 
action and specific gravity of urine. 

Urine is composed of 96% water and 4% solids, one-half of 
which is urea, The other half is made up of phosphates 
(earthy and alkaline) , sulphates of sodium and potassium, 
chloride of sodium, uric acid, hippuric acid, extractives and 
the coloring matters — indie an, urobilin and uro chrome. 

The normal reaction of urine is acid and the specific grav- 
ity 1020. 

Describe the temporary and permanent teeth. 

The temporary or milk teeth are twenty in number, ten in 
each jaw. From the front backward we have in each side 
of the jaw two incisors, one canine and two molars. The 
first tooth to erupt is the lower central incisor about the sixth 
month. This set is complete about the thirtieth month. 
About the sixth year the jaw has enlarged considerably; as 
a result there is room for another tooth and the first per- 
manent tooth, the six-year molar, erupts. Then the incisors 
are erupted, pushing out in front of them the temporary 
teeth. The last permanent tooth to erupt is the third molar 
or wisdom tooth, about the twenty-first year. 

There are thirty-two permanent teeth, sixteen in each jaw. 
From the front backward in each side of the jaw we have 
two incisors, one canine, two bicuspids and three molars. 
The incisors cut the food, the canines tear it and the molars 
grind it. 
9 



130 t PHYSIOLOGY. 

Through what medium is the blood relieved of effete 
matter and provided with new material? 

The blood is relieved of effete materials through the sweat, 
urine, feces and exchange of respiratory gases in the lungs. 

It is provided with new material through the respiratory 
exchange of gases, from the gastrointestinal tract through 
the portal vein and lacteal®, and from the ductless glands, as 
the thyroid, spleen, adrenals; also* from marrow of bones. 

How is normal body temperature regulated and sus= 
tained? 

It is regulated by the thermotaxic centers; of the nervous 
system, and sustained by metabolism of the tissues, especially 
the muscular and glandular. 

State where in the human economy the following sub= 
stances are found: fibrin, chondrin, leucin, hippuric acid. 

Fibrin is found in clotted blood, chondrin in cartilage, 
leucin in the intestines, hippuric acid in urine. 

What stimuli produce muscular contraction? What is 
the nervous mechanism of muscular contraction? Illus= 
trate. 

Stimuli producing muscular contraction are the normal 
nervous stimulus, electrical, mechanical, chemical, and 
thermal. 

In the nervous mechanism of muscular contraction, the 
motor impulse starts from the motor nerve cell, passing down 
the motor neuraxon to the motor end plates, and here the 
muscle cells are stimulated to contract. One stimulus would 
simply cause a muscular twitch, but normally in a muscular 
act a series of impulses are sent from the nerve centers to 
keep the muscles in a voluntary tetanus. 

In raising the foot the motor impulse starts in the cere- 
bral grey cells of the Rolandic area, passes down to the cells in 
the anterior born of the opposite side of the lumbar cord, then 
out through the sciatic nerve to the motor end plates of the 



PHYSIOLOGY. 131 

muscles required to lift the foot, which in turn stimulate 
the muscular fibers. 

Define stammering and state what causes it. 

Stammering; is a defect of speech due to the spasmodic 
action of the diaphragm interrupting the flow of air past the 
vocal cords. The larynx and lips are under control. 

Define and describe respiratory rhythm, respiratory 
sounds. 

Respiratory rhythm is the relation between the time of in- 
spiration and expiration. Inspiration is to expiration as five 
is to six, the expiration being followed by a short pause. 

The respiratory sounds are the sounds heard in auscultating 
the lungs. There are two sounds. One is the vesicular 
breathing, which is a low-pitched, soft, distant breezy sound, 
the inspiration being to expiration as three or four is to one, 
in fact expiration may be a mere puff. 

The second is the bronchial breathing, heard over the 
trachea and primary bronchi. It is high-pitched, blowing or 
tubular in quality, the expiration being louder, a little longer 
and higher pitched than inspiration. 

What are the functions of the skin and its appendages? 

The skin and its appendages protect from drying and 
other injury the underlying tissues, especially the end or- 
gans of the sensory nerves in the skin. The hair prevents 
friction and also protects sensitive parts from extremes of 
temperature. On account of the large extent of its surface 
and also on account of the sweat glands it contains, the skin 
is a great heat-dissipating organ. 

Define myopia, hypermetropia, astigmatism. State the 
cause of each of these conditions. 

Myopia or nearsightedness is a defect in vision in which 
parallel rays of light are focussed in front of the retina. It 
is due usually to an increased length in the anteroposterior 
diameter of the eye. 



132 PHYSIOLOGY. 

Hypermetropic or farsightedness is a defect in vision in 
which parallel rays of light are brought to a focus beyond 
the retina. It is generally due to a shortening of the an- 
teroposterior diameter of the eye. 

Astigmatism is an error of refraction in which rays of light 
in the various planes are not equally refracted, some of the 
rays possibly being fo cussed on the retina, others behind or 
in front of it. It is generally due to irregularities in the 
curvature of the cornea, but sometimes of the lens. 

What is the physiologic function of the liver? 

The liver secretes bile, forms glycogen, urea, uric acid, con- 
jugate sulphates, destroys some of the red corpuscles and in 
fetal life forms some red corpuscles. It also destroys many 
poisons taken into the body. 

State the manner in which blood circulates through the 
heart and the lungs, beginning at the right auricle. 

The blood passes from the right auricle through the tri- 
cuspid valve into the right ventricle; thence through the 
pulmonary valve into the pulmonary artery, which divides 
and subdivides, finally ending in the capillaries around the 
air cells. The bloo'd is re-collected and emptied by the pul- 
monary veins into the left auricle; then it passes on through 
the mitral valve into the left ventricle ; it is then forced out 
through the aortic valve into the aorta. 

Compare arteries, veins and capillaries in respect to 
rapidity of the blood stream. 

The blood flows in the arteries at about the rate of twelve 
inches a second, in the veins seven inches a second, and in the 
capillaries two inches a minute. 

. Name the excretory glands of the body and the function 
of each. 

The excretory glands are the kidneys, which excrete urine ; 
the sweat glands, which excrete sweat and dissipate heat by 
sweating; and the liver, which throws off through the bile 



PHYSIOLOGY. 133 

some waste matter. The lungs are also excretory organs, 
throwing off carbon dioxide and nitrogen. 

Describe the origin of a tear as the result of pain. 

The pain causes reflexly a stimulation of the lachrymal 
gland, causing an increased secretion. More secretion is 
poured out than can foe carried off by the lachrymal canal, 
the excess pouring over the cheek as tears. 

What is the office of the columnae carneae? 

They give strength, to the ventricular wall and prevent 
the auriculo-ventricular valves from being pressed into the 
auricles. 

Describe the physiologic causes of obesity. 

The physiologic causes of obesity are overfeeding, espec- 
ially with carbohydrates, lack of proper exercise, and cer- 
tain peculiarities of the cells of an individual. 

Name some of the bodily states which lessen the alka= 
Unity of the blood. 

There is a decrease of alkalinity in rheumatism, gout, mi- 
graine, and while living on a diet deficient in the alkaline 
mineral matters, or living on a proteid diet. 

What is the influence of diet on nutrition? 

For nutrition to go on properly the diet must contain the 
various classes of foods in proper proportion. Proteids and 
salts are absolutely necessary. Nothing but proteids can 
replace the used-up proteids of tissue. Salts are needed 
especially to neutralize the acids; formed during proteid 
katabolism, and to form a part in the secretions, like the 
hydrochloric acid of the gastric juice. 

Describe the physiologic process by which the bite of a 
venomous snake or the hypodermic injection of the virus 
causes death. 

The poison injected under the skin is carried by the 
lymphatics to the right or left subclavian vein. Having thus 



134 PHYSIOLOGY. 

reached the general circulation, it is distributed to the vari- 
ous organs, and so perverts the function of certain ones as 
to cause death. 

Name the bile salts, and state the physiologic function 
of bile. 

The bile salts are sodium glycocholate and sodium tauro- 
cholate. 

Bile aids in the emulsihcation and absorption of fats, neu- 
tralizes the acid chyme, precipitating the pepsin, increases 
peristalsis, and contains some waste matter thrown 'off by 
the liver. 

Describe the offices and the characteristics of the gray 
matter of the brain. 

The gray matter of the cerebral cortex is arranged in six 
alternate gray and white layers, the most important of which 
is the deep gray layer of large pyramidal cells. 

The gray matter of the cerebrum is the center of sensa- 
tion, volition and ideation; that is, it receives the sensations, 
sends out all voluntary impulses and is the part of the 
nervous system in Which thought goes on. 

Enumerate the physiologic advantage of natural sleep 
and state at what period of life the least sleep is required. 

- Natural sleep allows the fatigued nervous system to re- 
gain its tone, causes a relaxation of the vasomotor system, 
thus giving the heart a chance to rest. In fact, sleep causes 
a relaxation of all the bodily functions, thus allowing the 
tissue to recuperate and waste matter to be carried off. 

During mature adult life the body can stand the lack of 
sleep better than at any other time. 



HYGIENE. 



What principal hygienic direction should be given a 
patient suffering from tuberculosis? 

Always expectorate into or on such appliances as may, 
with their contents, be disinfected or 'burned. Avoid kissing. 

How can malarial districts be made healthy? 

Remove moisture from the locality by surface or sub-soil 
draining ; by planting trees like the eucalyptus, which require 
much water for their growth ; by preventing the development 
of the mosquito larvae, through the action of petroleum on 
water surfaces. 

Differentiate between endemic and epidemic diseases. 

An endemic disease is one constantly present in a com- 
munity. An epidemic disease is one which spreads rapidly, 
attacking many people at the same time. 

State the results to animal life of the combustion of 
fuel in a room without chimney connection or other 
ventilation. 

Carbon monoxide poisoning, suffocation due to excessive 
quantity of carbon dioxide and diminished amount of oxygen; 
a systematic poisoning due to breathing products which are 
the result of partial burning of excretions thrown off in ex- 
halations. 

What is the best method of disposing of the bodies of 
those who have died of yellow fever? 

Cremate such bodies. 

(135) 



136 HYGIENE. 

What is meant by natural and acquired immunity from 
disease? Give an example of each. 

By natural immunity we mean ' ' that inherited trait from 
immune ancestors which enables an organism to resist the 
attacks of 'bacteria and their toxic secretions." Thus, as a 
rule, the negro race do not contract yellow fever. By ac- 
quired immunity we understand that through a previous 
attack of an infectious disease, or by inoculation with an 
attenuated virus of that disease, the blood of the person 
undergoes such changes as to present a non-fertile soil to the 
organism to Whose presence the disease is due. Example, 
vaccination in preventing small-pox. 

What are the principal measures which you would 
employ for the prevention of the spread of infectious 
diseases? 

Isolate the patient and attendants ; disinfect all substances 
removed from patient's room before their removal; establish 
the purity of water and food supplies; disinfect the room and 
contents after patient's removal, and observe a precautionary 
quarantine. 

How would you prepare an artificial food for a new= 
born infant? 

Render cow 's milk as alkaline as human milk. Dilute with 
water to reduce the quantity of casein to what it would be 
in maternal milk. Fat and sugar are increased by the addi- 
tion of cream and sugar of milk. To one pint of sterilized 
water 17% drachms of pure commercial sugar of milk are 
added and dissolved. This sugar water must be kept in a 
cool place and not be allowed to sour. When feeding time 
arrives two tablespoonfuls of cream, one of milk, two of lime 
water, and three of the milk-sugar water are mixed, and as 
soon as this mixture has been warmed to proper temperature 
it may be poured into a bottle and the food is ready for use. 
(Fisher.) 



HYGIENE. 137 

What are the properties of oleomargarin compared with 
butter made in the usual way? 

Butter fat contains nearly 8% of the volatile fats; specific 
gravity never below 909.8; insoluble fatty acids form about 
88 % of the weight of butter fat; melting-point of fat is 
between 86° and 94° F. ; readily and completely soluble in 
ether. 

Oleomargarin fat contains about %% of the volatile fats; 
specific gravity never above 904.5 ; insoluble fatty acids form 
about 95% of the total weight; melting-point rarely above 
82 °F. ; less soluble in ether and leaves a residue. 

State the value of public baths to the health of a large 
city. 

They 'give facilities to the poor for obtaining personal clean- 
liness, exerting a protective influence over the development 
and spread of filth diseases. They encourage the young to 
learn to swim, and supply an excellent form of exercise, pro- 
moting growth and development. When properly used their 
effects are both tonic and stimulating. 

What is sewer gas? How does the inhalation of sewer 
gas in large quantities affect the system? 

Sewer gas is a mixture of a number of gases, among which 
we find carbonic acid gas, light carburetted hydrogen, nitro- 
gen, hydrogen sulphide, ammonium sulphide with fetid organic 
matter, the volatile and semi-volatile results of animal and 
vegetable decompositions, 

Sewer gas gaining entrance to house or room may exert a 
depressing influence upon the occupants, and may occasion 
vomiting, purging, severe headache, prostration, and through 
its carriage of germs cause infectious diseases. Yet sewer 
gas per se is sometimes almost innocuous. A chronic form 
of poisoning from sewer gas gives rise to pallor, langour, 
frequent headaches, loss of appetite, diarrhoea, generally im- 
paired health and anemia. 



138 HYGIENE. 

Is green wall=paper objectionable; if so, why? 

Sometimes, because its color may 'be due to a compound of 
copper and arsenic, which after becoming damp dries, and is 
rubbed or blown from the walls, producing acute or, more 
often, chronic forms of arsenical poisoniing as well as me- 
chanical irritation of fauces, conjunctiva, etc. 

Contrast the incubative stages of variola and measles. 

The incubative stage of variola is from six to seven days 
by dnnoculation, and from ten to fourteen days by infection. 
In measles it is from seven to ten days by inoculation and 
from seven to twenty-one days by infection. 

What conditions and diseases in animals render their 
flesh unfit for food? 

" The flesh of all animals dead of internal diseases, or 
which have been killed while surfer lug from such diseases or 
animal killed by overdriving. The flesh of animals with 
contagious diseases that may be 'transmitted to man. The 
flesh of animals that have been poisoned. The flesh of ani- 
mals with severe infectious diseases, as pyemia, etc. Flesh 
containing parasites that may be transmitted to men. AH 
putrid flesh " (Gerlach). 

Discuss detached wards versus many=storied buildings 
for a public hospital. 

Many wards in one building render the maintaining of dis- 
cipline and supervision easier. Quicker service, ease of com- 
munication, greater economy of administration are favored 
by many wards. Many-storied buildings prevent perfect iso- 
lation and ventilation, render diminished supply of sunlight, 
lead to danger, as in removal, should fire occur ; so that the 
detached ward system seems preferable. 

Give a fair average death rate (a) in rural districts, (b) 
in towns of from 5,000 to 20,000, (c) in cities of* over 
100,000 inhabitants. 

(a) 14, (b) 17, (c) 19 to 22 per thousand. 



HYGIENE. 139 

Mention five preventable diseases. 

Tuberculosis, typhoid fever, cholera, yellow fever and 
malaria. 

Give the special hygiene of factories in which women 
and children are employed. 

Each child or woman should be allotted sufficient space to 
supply 3,000 cubic feet of fresh air an hour by a not greater 
air movement than that which 'would change the air three 
times each hour. The temperature should be kept constant 
.at about 65 degrees Fahr. Means should be employed to 
quickly remove dust or offensive and dangerous gases. Per- 
sonal cleanliness should be facilitated ny properly equipped 
wash-rooms. The water-closet fixtures should be ample and 
of proper construction. An infirmary should be provided 
for immediate treatment of injuries and suddenly occurring 
illnesses. 

In the selection of a site for a dwelling what is the best 
sanitary soil, sub=soil and topography? 

A light, dry soil, as of gravel or sand, that contains no 
absorbed filth or sewage, with a nearly constant level of 
ground water, avoiding clay or impermeable material both in 
^the soil and in the sub-soil. The location should not be in 
low-lying districts, nor in localities which from the geolog- 
ical formation act as collectors of underground water. The 
house should not be placed on the top of an elevation where 
it would be exposed to strong winds. All other conditions 
being favorable, the house should be built on the side of a 
hill so that it receives a maximum supply of air and sun- 
light, and in cold climates preferably with a southern ex- 
posure. 

What is the bubonic plague? What steps can be taken 
to limit or extinguish such a scourge? 

It is an acute contagious and infectious disease favored by 
filthy surroundings and at times occurring epidemically. It 



140 HYGIENE. 

is due to a specific micro-organism and is characterized, 
among other symptoms, by glandular swelling terminating in 
abscess. Prevention depends upon isolation of the sick, thor- 
ough disinfection of the clothing, etc., and surroundings of 
the patient and the avoidance of overcrowding and filth, and 
the institution of rigid quarantine to prevent its dissemina- 
tion. 

Name the principal adulterations of wine. 

Water, coloring agents (logwood, red beets, coal-tar prod- 
ucts), flavoring agents (prunes, peaches, raisins, dates, dried 
apples), preservatives (salicylic acid, formaldehyde), glycer- 
ine, alum and decolorizing agents. 

Give some of the requisites for the sanitary construc= 
tion of house foundations and cellars. 

To keep down the level of ground water subdrain if neces- 
sary to secure dryness. Coat the foundation inside and out 
with cement and provide a cement floor for the cellar. Admit 
plenty of air and sunlight into the cellar. 

What is your view concerning the propriety or neces= 
sity of inserting vaccine virus in multiple places? 

The duration of the protection from small-pox is said to 
be directly proportionate to the number and size of vaccine 
vesicles ; so vaccinate in at least two different places and 
let the combined area of vesicle resultant measure over half 
an inch. 

Give the prophylaxis of the filth diseases. 

Sanitary inspection of all houses and buildings with im- 
mediate abatement of any nuisances. Thorough cleanliness 
applied to persons, habitations and the community, and to 
houses of public use. Examination of water and food sup- 
plies, with correction of all disease-exciting causes. Sewage 
and waste removal systems to be placed in perfect operation. 
Isolation of patients sick with these diseases, and disinfection 
of rooms and property of such patients, and the establishment 



HYGIENE. Ill 

of house, municipal, state or national quarantine. Prevent 
access of flies and other insects to food and drink. 

What is the physical training for a weak heart when 
no valvular lesions exist? 

Beginning with gentle calisthenics, exercise should be taken, 
preferably in the open air, and increased gradually, such 
exercise to be supervised by a competent physician. Later 
on climbing exercises of a very gradual degree of difficulty 
may be taken. 

How many cubic feet or fresh air per hour are required 
by an adult? 

Three thousand cubic feet. 

Discuss the theory of hereditary tendencies as applied 
to tuberculosis. 

Children born of tuberculous parents present less power to 
combat and overcome the attacks of the tubercle bacilli than 
others of more healthy parents. Some theorists claim that 
this deficiency of resistance is in part due to an inherited 
small heart, and lessened circulatory power, thus favoring 
conditions of passive congestion or low grades of inflamma- 
tory processes. Such subjects as a rule show lessened lung 
expansion, a flattened or a wedge-shaped chest, etc. 

Describe the physiological action of alcohol. 

Small or therapeutic doses increase the pulse rate and the 
arterial pressure by directly stimulating the heart. Over- 
doses directly depress and paralyze the heart muscle. Large 
doses produce decided lowering of body temperature. It is 
probable that the use of alcohol diminishes the elimination of 
C0 2 . Alcohol causes a great lessening in the excretion of the 
products of tissue waste. It is probable that alcohol in not 
too large quantity is entirely destroyed in the body. In 
small doses alcohol acts as a cerebral stimulant, While larger 
doses greatly depress and abolish nervous activity, and check 



142 HYGIENE. 

digestion. The habitual use of alcohol is accompanied by a 
disposition towards fatty degeneration, particularly of heart 
muscle, liver and kidneys, and in enlarged and dilated con- 
dition of the smaller blood-vessels and a degeneration of all 
nervous structures. 

Does alcohol possess a food action? On what do you 
base your answer? 

Yes. ' ' In the sense that it is destroyed in the system and 
yields force which is utilized by the organism, and is when 
in sufficient quantity a retarder of tissue change, checking 
the excretion of nitrogen " (H. C. Wood). We see this in 
its -administration in typhoid and other long-continued fevers. 
Yet it is not a true food, since it also exerts toxic effects,, 
which foods no not. 

State your views on compulsory vaccination and relate 
the safeguard that should be employed in all cases of 
vaccination. 

The unprotected individual should be vaccinated as a pro- 
tection to himself and to those with whom he comes in contact. 
The virus employed must be free from contamination, and 
the instruments used should be perfectly sterile, and the 
operation should be performed on a clean surface. The 
wound should be adequately protected from irritation by 
clothing, and from pathogenic germs. 

In the pursuit of what trades is there a predisposition 
to pulmonary diseases? 

Trades carried on in over-crowded, poorly ventilated rooms, 
in damp localities. Trades that give rise to much dust, par- 
ticularly if such dust be of fine, hard particles, to which file- 
makers, stone-cutters, grinders, etc., are subjected. Such 
trades as necessitate cramped positions of the workers pre- 
venting proper lung expansion. In vocations giving rise to 
poisonous or obnoxious vapors, and also where the individual 
is exposed to sudden changes of temperature. 



HYGIENE. 143 

Under what condition is tyrotoxicon found in milk, 
cheese and other articles? 

Where milk, cheese, ice cream, etc., undergo decomposition 
in the presence of other organic matter, as rotting wood, 
mould, etc. 

The excavation of streets in cities is frequently fol= 
lowed by the outbreak of disease, such as diphtheria, 
typhoid fever. What is the cause? 

Pathogenic bacteria lie dormant in the soil of cities, and 
when such soil is exposed to the air, it becomes dried, and 
its contained bacteria taking on an active existence are liber- 
ated and carried by the air to susceptible individuals. 

Describe the agency of the ptomaines in inducing dis= 
eases and the disorders produced by them. 

Ptomaines are alkaloidal bodies resulting from decomposi- 
tion of nitrogenous substances. When absorbed into the 
blood they may give rise to fever, headache, torpor, fetid 
breath. They act like chemical poisons very soon after their 
introduction into the system. Many of them occasion dis- 
tinctive trains of symptoms. 

How long does a diphtheritic patient remain infective? 
How may it be proved that this infective period has 
ceased? 

About three weeks after local symptoms cease. Make fre- 
quent cultures of material from the affected site, and when 
such fail to show the specific germ, the patient will no longer 
be a source of infection. 

How may milk be the means of transmitting the germs 
of typhoid fever? 

Through water containing Eberth's bacillus gaining access 
to the milk, as through diluting the milk, washing milk re- 
ceptacles in polluted water. 



144 HYGIENE. 

State the period of incubation in (a) vaccinia; (b) paro= 
titis; (c) pertussis; (d) varicella; (e) rotheln. 

(a) 3 to 7 days; (ib) 14 to 22 days; (c) 2 to 8 days; (d) 
4 to 14 days; (e) 12 to 20 days. 

Mention the effects of working in phosphorus, as in the 
manufacture of phosphorus matches. How can the dan= 
gers be limited or prevented? 

Inhaling phosphorus fumes produces a form of necrosis of 
the jaw, particularly in such as have imperfect teeth. To 
avoid its development persons with sound teeth and freedom 
from abrasion of the interior of the mouth should be em- 
ployed. The work-room should be large and well ventilated, 
with special air-shaft to force the fumes away from face of 
workers, the employees should have short working hours, and 
frequently use a mouth wash and gargle of lime water or 
carbonate of sodium. Turpentine and charcoal should be 
exposed in the room. 

What fruits are preferable in cases of habitual consti= 
pation? 

Apples, prunes, figs, tamarinds, grapes and melons. 

Indicate a proper diet in the case of diabetes mellitus, 
obesity and early convalescence in typhoid fever. 

The diabetic should use only a small quantity of carbo- 
hydrate foods, with a relatively large quantity of proteid 
foods and fats. The patient suffering from obesity should 
use but little fluids or food containing much water. Food 
containing starch and sugar should be eaten sparingly, and 
alcoholic liquors and fa'ts must be avoided entirely. He 
should eat lean meats, mutton, beef, lamb, chicken, eggs, stale 
bread or toast sparingly, tomatoes, lettuce, eelery, asparagus, 
onions, ripe fruits of an acid nature but no sugar. 

In convalescence from typhoid fever the patient should use 
easily digestible food of a concentrated, nourishing character, 
of small bulk and without hard or irritating properties, as 



HYGIENE. 145 

soups, broths, uncooked oysters, eggs, rice, wine, milk, calves' 
foot jelly, etc. 

What is the chief unsanitary condition of sea=going 
vessels? 

The presence of bilge water and a dirty hold. 

Describe the manner in which antitoxin is prepared. 

A virulent culture of the specific micro-organism, or a 
strong toxin is injected into the cellular tissue of the selected 
animal, under due precautions of aseptic operation. After 
the animal has recovered from the symptoms thus produced, 
another and stronger injection of the specific poison is given. 
Injection after injection of increasing strength is given at 
proper intervals, until the animal fails to show any further 
symptoms of the disease — after an injection. Blood is then 
taken from the jugular vein of the animal, the greatest care 
being observed to secure aseptic conditions. This blood re- 
ceived in sterilized flasks, which are then stoppered, is stored 
in refrigerators until separation of clot and serum occurs. 
The serum is now tested to determine its value as antitoxin 
and then, after the addition of a very small proportion of 
carbolic acid, is placed in small vials, which are then her- 
metically sealed. Each vial has marked upon it its strength 
in normal antitoxin units in each cubic centimeter, and usually 
contains one dose. 

Mention some of the objections to curbed or driven 
wells in streets or houses with respect to the purity of 
water coming from these wells. 

The curbing rarely affords protection to the well water 
from gases and other emanations from sewers, gas-pipes, 
drains, etc., and even though a driven piped well may take 
its water from far below the surface, yet in the streets of 
cities, with the ever-present sewer and gas pipes, the soil 
becomes so saturated with deleterious material as to greatly 
endanger, through water carriage, the water from all forms 
of wells. 
10 



146 HYGIENE. 

From what disease may immunity be acquired in the 
case of persons who have once suffered from these dis= 
eases? How is knowledge of this fact utilized in the 
prevention of certain diseases? 

Yellow fever, small-pox, scarlet fever, chicken-pox, per- 
tussis, typhus fever, cholera. A partial immunity may result 
in measles, mumps and in typhoid. 

We may prevent some of these diseases by the introduction 
into the patient's system of the particular antitoxin of the 
threatened disease. 

Describe the effect of a hot and moist climate on the 
human system, and state the class of diseases this atmos= 
phere is likely to induce. 

In hot and moist climates the inhabitants, as a rule, are 
of small stature and 'deficient in muscular development; of 
languid disposition and nervous temperament. The diseases 
most prevalent are those affecting the liver and gastro-intes- 
tdnal tract ; also various forms of malarial disease and yellow 
fever. 

What occupations are a menace to public health? Why? 

Those occupations that emit irritating, poisonous or nox- 
ious fumes and 'gases, from the vitiation of the atmosphere, 
as in fertilizing plants, chemical manufactories, bone-boiling 
establishments; also dust, especially if this be of sharp, hard 
character, as from cement-making, tool-making, the respi- 
ratory tract being thereby subjected to irritation. 

Mention some of the objections to storage cisterns under 
ground. What are the objections to rain water as a drink? 

They often receive dust and dirt; sewer gas may gain 
entrance to the water when the " standing waste " or over- 
flow pipe of such a cistern is connected with the drain or 
soil pipe of a house. Storage cisterns cannot be properly 
ventilated, and are often difficult to clean. 



HYGIENE. 147 

If the first part of the rain be collected, such water will 
contain! dust, pollen, gases and other matters washed from 
the air. 

Mention some of the diseases to which artisans are 
especially liable. 

Painters, and those working in lead, copper land zinc, may 
suffer from metallic poisoning; match-makers from phos- 
phorus poisoning; tool-makers and grinders from phthisis; 
miners from affections of 'bronchi and lungs ; smelters from 
arsenical poisoning. 

Given an opinion as to the sanitary effect of the different 
methods of heating houses. 

The most desirable method is by hot water heating by 
means of a complete plant with circulation of the hot water 
through radiators. Next in value to hot water heating is 
steam heating by radiators or by indirect radiation. The use 
of open fireplaces in the principal rooms is of great value in 
securing ventilation, but yields an unequal and insufficient 
supply of heat. Heating a house by hot air from basement 
heaters is efficient and gives good results, if 'the air supplied 
to the heater for distribution is pure and the house is not 
too large. 

State average weight of feces in 24 hours in a nor= 
mal man. What proportion is made up of liquid and 
what of solid contents? 

Six ounces, 75 per cent, of which is water. 

Name eight principal carbohydrates used as food. 

Starch, glucose, saccharose, lactose, dextrin, cellulose, mal- 
tose and dextrose. 

Name the class of foods which should be given to chil= 
dren between the first and second years of age. 

We should supply foods in about the proportion of 2 parts 
proteid, 3 parts fat, 6 parts carbohydrates, the proteid food 
preferably milk. 



148 HYGIENE. 

How do forests benefit public health? 

Forests act as wind barriers, promote humidity of the air 
from the widespread surface they offer for evaporation. 
They afford shade in summer, and aid in decreasing the rela- 
tive quantity of -cartoon dioxide in the air, exhaling oxygen to 
the air. 

State in a general way the maximum number of hours 
that primary pupils in the public schools should be kept 
at their tasks, and how frequently and in what manner 
such tasks may be varied and broken. 

One-half hour at a given task is sufficient when the char- 
acter of the mental work should be changed. When an 
hour's mental application has been enforced, then five or ten 
minutes should be given to light calisthenics. An intermis- 
sion of fifteen or twenty minutes in the open air should 
occur in the course of three hours' study. An intermission 
of (two hours should then be allowed for luncheon and recrea- 
tion, at the end of which time a similar routine may be fol- 
lowed, as stated above, for two hours. 

What abnormal condition of the eye is most common 
in school children? 

Myopia. 

What are some of the dangers involved in the domestic 
use of ice? 

Ice may contain pathogenic bacteria, and may, when re- 
moved from a sick-room transmit infectious disease to other 
members of the household. 

What is the expectation of life of a professional man 
in active practice at the age of 45 years? 

. 24.82 years. 

Define the term "quarantine;" mention the principal 
quarantinable diseases, and give the rules for determining 
the length of time each should be quarantined. 

" The adoption of restrictive measures to prevent the in- 



HYGIENE. 149 

traduction of diseases from one country or locality into an- 
other " (Wyman). 

Quarantinable diseases include Cholera, small-pox, yellow 
fever, plague, scarlet fever, diptheria, typhus fever, relaps- 
ing fever, cerebrospinal meningitis, leprosy. 

In eruptive fevers isolation of the patient (quarantine) is 
continued for two weeks after the eruption has disappeared 
except in the case of small-pox where quarantine lasts 30 days. 

The quarantine in diptheritic cases does not cease until 
cultures made from the throat of the patient fail to show 
the bacillus of diphtheria. 

State the best means of disinfecting sputum. 

Sputum should be burned or be received into vessels con- 
taining strong antiseptic solutions. 

What is understood by the germ theory of disease? 
Mention all diseases whose causes are known to be spe= 
cific micro=organisms. 

The germ theory of disease icontends that the exciting 
cause of each infectious or contagious disease is some specific 
organism, and that these diseases are communicated only by 
the transference to and development of the particular para- 
site or germ within or upon the tissues of the infected in- 
dividual. 

Diseases due to specific micro-organisms are tuberculosis, 
diphtheria, cholera, typhoid fever, dysentery, pneumonia, 
glanders, leprosy, anthrax, erysipelas, gonorrhea, relapsing 
fever and tetanus. 

What diseases are incident to school life? How may 
these diseases be prevented? 

The infectious diseases, which should be prevented by early 
recognition and prompt removal of sick pupils. The room 
should be disinfected. Curvature of the spine should be cor- 
rected or prevented by properly constructed school furniture, 
and proper admission of light to the room. Myopia should 



150 HYGIENE. 

be prevented by the use of clear, large print in text-books 
and correction of improper positions in reading and writing 
and a good supply of light admitted to the school-room to 
the left of the pupils. 

Contagious conjunctivitis, prevented by cleanliness and 
isolation of the patient. 

Chorea, prevented by removal of the afflicted and repres- 
sion of all the tendencies toward imitation. 

What is the value of preventive inoculation in cholera 
and diphtheria? 

Value in cholera not yet fixed. In diphtheria, antitoxin is 
both curative and prophylactic. 

Outline the construction of a camp hospital, especially 
providing for the care (with least danger to other patients, 
medical and surgical) of those suffering from contagious 
diseases. 

Obtain purity of internal 'atmosphere; abundance of pure 
air and sunlight within the building, facility of administra- 
tion and discipline. To obtain these requirements select a 
proper site of soil, not clay, and preferably on hillside, look- 
ing southward if in winter; use a simple plan of building, 
a sufficient number of wards, preferably on the detached or 
pavilion plan. In wards each patient should have at least 
90 square feet of surface space, and 1,200 cubic feet of air 
space; have provisions for burning all infected material, dis- 
charges, etc., to leeward of the hospital and at a suitable 
distance away. 

Can it be proved that the diminished death rate from 
diphtheria so generally announced is due to the use of 
diphtheria antitoxin? Give reasons. 

Yes, By comparing the death rate in hospitals treating 
the same class of patients, in the same community, during the 
same time, the one hospital using diptheric antitoxin, the 
other depending upon other methods of combating the dis- 



HYGIENE. 151 

ease. Where the antitoxin is used the death rate is much 
lower. 

Give the comparative nutritive value of sterilized or 
unsterilized cows' milk. 

The nutritive value of sterilized milk is less than of milk 
unsterilized. 

What evil consequences frequently result from the ex= 
cessive use of tobacco? 

Catarrhal inflammation of pharynx, tonsils and mouth. 
Nervous disorders of heart las palpitation, and insomnia also 
result. Derangements of stomach with loss of appetite, and 
impairment of vision together with paralysis of optic nerve, 
nervous tremors, and muscular twitchings may result. 

How should a patient who has been rendered uncon= 
scions by heat be treated? 

If the patient has a strong, full pulse and the face is red 
and congested, place him in a recumbent position with the 
head reaised and apply ice until the high temperature falls 
to about 100 degrees Fahr. 

If the patient is pale, with a weak pulse, use stimulants, 
as ammonia, by inhalation ; apply heat to the body and keep 
head, face and neck cool. 

Mention some of the advantages of carefully prepared 
artificial ice as compared with natural ice. 

It may be made from distilled water so as to be absolutely 
pure. It may be obtained in any size or shape and its tex- 
ture is more uniform. 

What precautions as to food and drink should be ob= 
served by those forced to work under the direct rays of 
the sun in summer weather? 

A small quantity of readily digestible food should be eatten 
before going to work. Liquids of a non-alcoholic character 
may be used liberally, provided perspiratory function is ac- 



152 HYGIENE. 

tively performed. Very cold drinks should 'be avoided. Meat 
should be largely excluded from the diet. 

A law to prevent owners of land in the narrow streets 
of New York City from erecting buildings more than 
twelve stories in height is being agitated. Give sanitary 
and hygienic reasons for and against. 

Reasons favoring tall buildings: The persons using the 
upper floors are insured uninterrupted sunshine, good light, 
a pure air, comparatively free from street dust, and free- 
dom from ground air and water. 

Reasons against : Tall buildings prevent proper ventilation 
of lower buildings, and obscure sunlight from smaller build- 
ings and the street. Fire is difficult to extinguish in tall 
buildings. Their lower floors are often damp and generally 
dark, requiring the constant use of artificial illumination. 
They are, (therefore, a menace to the lives of their occupants. 

What are the best methods of ventilating dwellings, 
and what sanitary principles are involved? 

The perflating action of wind should be utilized at least 
once each day for all rooms. One of the best methods em- 
ployed is the open fireplace, provided such fireplaces be sup- 
plied with properly constructed chimney exits. In lieu of 
this plan fresh air may be admitted through ventilators, or 
between the upper and lower window-sashes. The object 
sought in these devices is to admit cold air above the heads 
of the occupants of the room so that the fresh air may pass 
through the upper portions of the room and become heated 
before reaching the occupants. The usual outlet for foul air 
is the chimney flue, but when this is not present, it may be 
replaced by an opening for the exit of air placed near the 
floor of each room. When the incoming air is not heated the 
outlet should be at the top of the room. During cold weather 
the rate of interchange of air should not be greater than 
sufficient to change the air of the room three times an hour. 
The air which enters should not have a greater velocity than 
five feet per second, or about 3.4 miles per hour. 



HYGIENE. 153 

What hygienic precautions should be observed in the 
care of the new=born child? 

The room should be kept at a temperature of about 72° 
Fahr. and well ventilated without draught. The child should 
be thoroughly cleansed, using a neutral fat to facilitate the 
removal of all fatty or sebaceous material before washing 
with warm water and castile soap. The eyes and surround- 
ing parts should in particular be thoroughly cleansed; if 
possible, without the aid of soap. After thoroughly drying 
the infant, its navel should be properly dressed. The infant 
should then be warmly clad, kept dry and clean, and away 
from noise and strong light. 

What hygienic precautions are necessary to insure 
healthy sleep? 

A well-ventilated room, temperature about 60° F. Room 
and bed should be perfectly clean, and the covers of the bed 
not too heawy. The head of the person should be slightly 
elevated. Noise and light should be excluded from sleeping 
apartments. 

What deleterious gases accumulate in improperly ven= 
tilated sleeping rooms? 

Carbon dioxide ; carbon monoxide, if rooms be heated ; hy- 
drogen sulphide ; ammonium sulphide, and many gases of an 
organic ammoniacal character. 

Does change in climate require any change in food; if 
so, what? 

Yes. In cold climates a greater quantity of food should 
be consumed than in hot climates. Food that is productive 
of the greatest number of heat units, as fats and meats, 
should be partaken of in cold climates. In hot climates the 
diet should consist almost entirely of well-cooked vegetables 
and ripe fruits, with the avoidance of alcoholic beverages. 

What are some of the dangers of the cold bath? 

In those of feeble circulation and at the two extremes of 



154 HYGIENE. 

life, chilling of the surface of the body leading to internal 
congestion that may result in acute inflammation, particu- 
larly of the lungs, kidneys, stomach and bowels. Shock seri- 
ously affecting the heart ; and the production of a persistently 
lowered 'temperature of the body. 

What effect has ground air and water on the health? 

Ground air is always impure, being contaminated with 
bacteria, carbon dioxide and often with mere poisonous 
gases. It occasions various degrees of ill-health, varying from 
slight general malaise to one of the acute infectious diseases 
or tuberculosis. Ground water from near the surface of pol- 
luted soils may be noxious. It causes dampness of the walls 
of houses, inviting rheumatic diseases and catarrhal inflam- 
mations. 

What hygienic principles should be observed in infant= 
feeding? 

Feed the child every few hours during the day ; and about 
three times during the night till several months old; then 
less frequently. If possible let the child receive its natural 
food from the mother, and in such oases take particular pains 
to see that the nipples and breasts of the mother are kept 
dry and clean between the times of nursing. If the infant 
is to be given artificial feeding, the cow's milk selected must 
be from a healthy animal, must be diluted with water to 
give a relatively less proportion of casein', must be sweetened 
with milk sugar, and have a slight addition of fats in the 
form of cream added, when it will approach human milk in 
composition. A definite quantity of milk which should be 
warmed to the temperature of the body should be given at 
each feeding. 

Define the word " nuisance " in a broad hygienic sense. 

" Something which either actually injures, or is likely to 
injure health, and admits of a remedy either by the indi- 
vidual whose a-cjt or omission causes the nuisance, or by the 
local authority" (Wynter-Blyth) . 



HYGIENE. 155 

What should be the height, weight and chest measure 
of a typical man aged 25 years? 

Height 67.8 inches ; weight 139 pounds ; measurements of 
chest 34.5 inches. 

What injurious influences, if any, do cemeteries exert 
on the health of persons living in their vicinity? 

To most persons the mental effect is depressing. Water 
passing through the soil of cemeteries may contaminate the 
water supply of the neighborhood with organic material and 
micro-organisms. The constant turning of soil of cemeteries 
may set free imprisoned gases from organic decomposition, 
and lead to contamination of the surrounding air. 

What physical conditions would render the taking of a 
Turkish bath inadmissible? 

Atheromatous arteries generally, diseases of the lungs, and 
diseases of the heart. 

What gases and combination of gases are most efficient 
as disinfectants? 

Formaldehyde, sulphur dioxide, chlorine, ozone. 
What care should be employed in exhumations? 

The exhumation of those dead of contagious or infectious 
diseases should not he allowed. When possible, the exhuma- 
tion should be deferred until cold weather. The presence of 
all persons except those absolutely needed should be forbidden. 
As the workmen (approach the coffin the earth should have 
poured upon it a strong watery solution of creolin. The 
coffin ■containing the remains should not be opened, but be 
placed at once in a zinc-lined box and hermetically sealed. 

What are the hygienic requirements and the physio= 
logical effects of bathing? 

The bath should be taken to obtain personal cleanliness, as 
well as for its stimulation of the peripheral circulation. 
Bathing should be postponed until at least two hours after a 



156 HYGIENE. 

meal, and should consume only twenty minutes. Never bathe 
When very hungry, or when the body is overheated. Unless 
experience has shown that good effects accrue from a cold 
bath, secure a temperature of about 65 to 75 degrees Fahr. 
of the water. The bath should be followed by a thorough 
drying and brisk rubbing. Effects following a bath are re- 
moval of dirt and of dead epithelium from the person, stim- 
ulation of the functional activities of the skin; a general 
improvement of the organs of elimination. 

How much fresh air is required for normal respiration 
during 24 hours? 

3,000 cubic feet per hour, or 72,000 cubic feet of air in 
24 hours. 

What is the best sanitary disposition of stable manure 
in large cities? 

The liquid portion of manure should be carried by prop- 
erly constructed trapped drains into the general sewer. The 
solid, dried manure, straw, etc., should be placed in well- 
covered pits, from which it could be removed at proper in- 
tervals in covered wagons, and employed in the country as 
fertilizer; or drain the liquid manure into the sewer and 
cremate the solid manure. 

How may a privy in a city or country be kept while in 
use from becoming a nuisance? 

Have the privy emptied at frequent intervals. At inter- 
vals of five to seven days, pour into the privy vault milk of 
lime (about 20 grains of lime for each gallon of sewage), 
or strong solution of iron sulphate; or at frequent intervals 
add clean, dry earth to the privy contents, and provide a 
ventilating pipe extending high in the air and down into the 
privy vault. 

What explanation can be furnished for the greater prev= 
alence of diphtheria and small=pox in cold than in warm 
weather? 

During cold weather the houses are less perfectly venti- 



HYGIENE. 157 

lated than in warm weather. Booms are frequently over- 
crowded, less attention is paid to personal cleanliness and 
there are more sudden changes in temperature. Such condi- 
tions lower the vitality of the body and predispose to disease. 

What are the principal adulterations of milk? 

Addition of water and abstraction of cream; addition of 
coloring matter (annatto, caramel) ; preservatives (borax and 
boracic acid, salicylic acid, formaldehyde, chro mates) ; gela- 
tine as a thickening for cream. 

What changes in food are effected by cooking? 

Parasites and germs are destroyed ; the food is made more 
tender to facilitate mastication. The tough fibrous envelope 
of starch cells is softened, albumin is coagulated, the food 
is rendered more palatable, and the action of the different 
digestive fluids is aided. 

Give the sanitary dimensions of a school=room for fifty 
pupils. 

A room 15 feet high, 25 feet wide and 40 feet long would 
allow each pupil 300 cubic feet of space, which is the ade- 
quate amount for each child. 

Mention eight satisfactory disinfectants and give indi= 
cations for their use. 

Formaldehyde (1 pound of formaline for every 1000 cu. ft. 
of space), sulphur (3 pounds for every 1000 cu. ft. of space) 
or bleaching powder (3 pounds for every 5000 cu. ft. of 
space) to fumigate a room. If sulphur or bleaching powder 
are used, it is necessary to steam the room before beginning 
to fumigate. Chloride of lime to disinfect excrementitious 
matter from typhoid fever, cholera, dysentery, etc. Carbolic 
acid (5% solution) or moist heat (steam and boiling water) 
to disinfect clothing. Bichloride of mercury or permanga- 
nate of potassium and oxalic acid to disinfect the skin. 



158 HYGIENE. 

What are the most common sources of infection in 
diphtheria? 

By direct contact with the sputum or shreds of membrane 
from the patient. By inhaling the air in the vicinity of the 
patient, By fomities, as clothing, hooks, drinking-cups, etc. 

What conditions are essential to a good water supply? 

Purity at its source, and adequate subsequent protection 
from contamination. 

What hygienic measures should be observed by the 
nursing woman? 

An abundant diet, avoiding overfeeding; some form of 
outdoor exercise each day; monotony of life and overwork 
should be guarded against. Warm clothing, personal clean- 
liness, abundant sleep, freedom from' mental cares, fright or 
anger are necessary precautions. Each time the child is re- 
moved from the breast the nipples should be washed with 
warm water and thoroughly dried. 

What precautions should a physician observe to avoid 
carrying contagious diseases? 

A linen duster and a tightly-fitting linen cap should be 
worn by the physician in the sick-room, and be removed 
after leaving the room. Immediately after manipulating the 
patient the physician should thoroughly wash and disinfect 
his hands and face. A bath and change of iclothing before 
attending other patients are advisable. 

Describe the hygiene of the mouth and teeth. 

The teeth should be cleansed after each meal and on rising 
in the morning, and foreign matter between the teeth should 
be removed. Acidity of the saliva may be counteracted by 
weak alkaline mouth washes. 

What methods would you suggest for the hygienic care 
of the skin? 

Simple foods : avoiding constipation ; daily exercise in the- 



HYGIENE. 159 

open adr; plenty of sleep (at least eight hours daily) ; fre- 
quent warm baths and a cold sponge hath on rising each 
morning. 

What localities should be sought or avoided by rheu= 
matic patients? 

Warm, dry, equable climate should be sought. Alkaline or 
sulphur thermal springs are recommended. Damp valleys, 
shores of rivers, sea coasts and places which are much ex- 
posed to winds and sudden changes of temperature should be 
avoided. 

Name the kinds of food and the quantity of each for the 
daily use of the normal man. 

4.5 ounces of proteid; 3.5 ounces of fats; 14 ounces of 
carbohydrates; 1 ounce of salts (Moleschott) . Or 118 grains 
proteids; 56 grains fats; 500 grains carbohydrates (Voit). 
These quantities represent dry foods. If the diet is stated 
as so-called solid-food (not water-free) the above quantities 
must be doubled. 50 to 80 ounces of water in liquid form 
are also taken into the system. 

What is the object of the wet pack, and what unfavor= 
able results may occur from its use? 

The cold wet pack is used to lower temperature during 
fever. The warm w^et pack is used to promote elimination 
of fluid, to relax muscular spasm, to promote sleep, and raise 
lowered vitality. 

The dangers to be guarded against are heart failure or 
fatigue, or excitement to weak patients. The cold pack maw 
give the patient a nervous chill. 

Describe in detail the process of disinfection by formal= 
dehyde (formalin). 

Make the room as near air-tight as possible by closing all 
openings and cracks before beginning the process of disin- 
fection. All mattresses, pillows, clothing, books, etc., should 
be exposed as fully as possible to the action of the disin- 



160 HYGIENE. 

fectant. Place one pound of formalin for every 1000 cu. ft. 
of air space in a ' ' Novy ' ' generator. Start the rapid vola- 
tilizing of the formaldehyde and allow the room to remain 
closed for one day. 

What hygienic means should be employed by persons 
prone to " catch cold?" 

A cold sponge oath followed by brisk rubbing on arising 
in the morning; daily muscular exercise in the open air and 
a liberal (but not excessive) diet, largely of carbohydrates. 

Describe the necessary sanitary precautions during the 
prevalence of an epidemic of Asiatic cholera. 

Isolate all patients and -attendants ; observe strict quarantine 
of all infected houses or districts; disinfect and remove any 
accumulations of filth, excreta, etc. ; cremate those who have 
died from this disease. The water supply should be guarded 
to prevent its contamination; and insist upon householders 
boiling all water or milk before using the same. All gastric 
or intestinal diseases should be attended to at once. Restrict 
or prohibit the use of all fruits or uncooked foods from the 
district; and use all disinfectant precautions where cases 
exist, during continuance of case, and after its termination. 

What are the sanitary requirements of house plumbing? 

All pipes and connections, traps, etc., should be in view or 
easy of access. Each house must be directly connected by 
pipe with the common sewer. The pipes in the house must 
be of iron with leaded joints or screwed couplings. The 
drainage pipes should be laid with a gradient of at least one 
inch fall to every four feet of length ; the main house drain 
must be provided with a trap after it has been carried beyond 
all house connecting pipes. Pipes from water-closet fixtures, 
bath-tubs, wash-basins and sinks must have traps close to 
each fixture. Soil pipes must extend open for at least two 
feet above the roof and air must be admitted to the main trap 
upon its house-side. 



EYG1EXE. 161 

Describe a simple form of ventilating the sick=room. 

Place a wooden strip about three inches wide and as long 
as the window frame under the lower sash; through the 
space between the top of the lower sash and the bottom of the 
upper, sufficient air will enter the room without producing a 
draught. 

What precautions should be taken in school=rooms to 
protect the sight of scholars? 

Pupils should not sit facing the windows (the light should 
come from behind or over left shoulder) ; blackboards should 
not have a glossy surface and should not be placed between 
windows. The walls of the room should be of a neutral tint. 
Text-books should be printed in clear, large type. Faulty 
posture in reading and writing should be corrected by the 
teacher. If toilet accessories are supplied, no child suffering 
with an innammatory disease of the eyes should be permitted 
the use of the general supply. Any imperfection in vision 
of a pupil should be reported to the parents. 

What are the chief sources of contamination to drink= 
ing water? 

The emptying of sewage into the stream from which the 
supply is obtained; surface water in settled districts gaining 
entrance to the supply; sub-soil water, after passing through 
a filthy soil ; drainage from places of burial ; and water which 
has dissolved poisonous minerals. 

Describe the several methods of purifying drinking 
water. 

Sedimentation, occurring when collections of water remain 
at rest for a considerable time, removing, in part-, at least, 
suspended matter. 

Sand filtration in which the water flows upon and through 

prepared beds of sand, gravel and broken stone, packed in 

separate layers, removes from it not only suspended matter, 

but also dissolved organic matter and bacteria, through the 

11 



162 HYGIENE. 

action of air (oxygen in the interstices of the filter material, 
and the action of saprophytic bacteria. 

Boiling water will free it of pathogenic bacteria and tem- 
porary hardness, bnt such water, after boiling, should be 
aerated to fit it for use. 

What do you understand by the " dry earth system " 
as applied to excrementitious matter? 

The container under the privy seat contains the dry earth, 
and after the use of the privy fresh earth is always to be 
added to the receptacle. From time to time the contents are 
removed and buried or otherwise disposed of. 

Contrast the incubative stages of measles and scarlet 
fever. 

The stage of incubation in measles is from one to three 
weeks (averaging 12 days) ; in scarlet fever from one to eight 
days (average 3 days). 

Mention some of the results of tobacco smoking in 
growing school boys in respect to the circulation, air 
passages, vision and mental application. 

It depresses the circulation and produces palpitation of 
the heart. It causes low grades of inflammatory processes 
in the upper air passages, 'Catarrhal conjunctivitis, mental 
lethargy, with inability to sustained mental application. 

What habits of school children tend to produce myopia? 

Reading of small imperfect print ; faulty positions while 
reading or writing in which the eyes are not far enough re- 
moved from the page; reading or writing in insufficient light, 
or when fatigued. 

What should be the proper temperature for a living 
room in winter? 

72°F. for old or weak persons; 65° F. for the young and 
vigorous. 



HYGIENE. 163 

What should be the diet of a child over two years of age? 

The food should consist principally of milk and bread, with 
rice, tapioca, some vegetables of easily digestible character, 
and sparingly of fruit, preferably cooked; but little meat 
should be allowed, and this preferably mutton. 

What hygienic precautions should be observed by a 
pregnant woman? 

Diet should be nutritious; clothing should be loose; mod- 
erate outdoor exercise should be taken each day ; the marital 
relations should cease; the action of the skin should be 
stimulated by warm baths. After the sixth month the urine 
should be examined every few weeks. Constipation should 
be corrected by hygienic measures when possible. In late 
pregnancy the nipples, if necessary, may be developed by 
judicious manipulation. 

What is the most sanitary way of disposing of city 
garbage? 

Burn it, so that all noxious vapors are also consumed. 
Describe the effects of a cereal diet. 

Many writers assert that, as a rule, such a diet produces a 
lessened muscular formation, with an increased fat produc- 
tion, and that it also causes a deficient production of red 
blood corpuscles, with an accompanying loss of oxidation and 
tissue removal; but it is probable that such a diet is com- 
patible with good health provided it contains enough proteids. 

What is the lowest temperature of steam heat at which 
pus cocci are destroyed? 

At 240 degrees Fahr. such organisms are killed in a few 
minutes, while at 212 degrees Fahr. it requires an exposure 
to steam of from thirty to forty minutes. 

What physical training would you recommend to a per= 
son with weak respiration? 

Calisthenic exercises without apparatus directed to increas- 



164 HYGIENE. 

ing the extrinsic and intrinsic muscles of respiration, accom- 
panied by deep and slow breathing. This should be followed 
by a course of light, well-regulated gymnastic work, with 
dumb-bells, Indian clubs and wands. After a proper interval 
of several months, progressively difficult mountain-climbing, 
then running exercises, and finally general apparatus work 
in a good gymnasium under proper instruction. 

Name three tests for detecting impurities in water. 

Nessler's test for detecting and estimating ammonia. 
Nitrate of silver for detecting and estimating .chlorides. 
Barium nitrate for detecting and estimating sulphates. 

What is the best sanitary plan for the disposal of 
sewage? 

Collect the sewage in large tanks and to it add lime, alum 
or iron sulphate. Compress the solid materials after their 
subsidence or precipitation and cremate them. Allow the 
liquid sewage to flow upon specially prepared filter beds 
which are subdrained, and the water flowing from these sub- 
soil pipes may then pass into a stream without great danger 
of adding poisonous material or pathogenic bacteria. 

What is the temperature of tepid water, of hot water, 
of boiling water? 

Tepid water 75 to 85 degrees Fahr. 
Hot water 100 to 110 degrees Fahr. 
Boiling water 212 degrees Fahr. 

What diseases are propagated by drinking water? 
How can their spread be prevented? 

Infectious diseases, particularly cholera and typhoid fever ; 
diseases due to gastric and intestinal irritation, as forms of 
dyspepsia, diarrhoea, dysentery; diseases due to animal para- 
sites ; diseases due to metallic poisons. 

Prohibit the use of water containing any dissolved metal. 
Distil the water, or boil it for at least one-half hour, thus 
purifying it. 



HYGIENE. 165 

Describe in detail the sanitary precautions necessary in 
typhoid fever. 

Expose urine, stools, vomitus and sputum for three hours 
to the action of a solution of chlorinated lime, of the strength 
of six ounces to a gallon of water, breaking up all solid 
masses. Place all towels, napkins and bed linen in a 5 per 
cent, solution of carbolic acid until convenient to boil the 
same for half an hour. Secure continuous ventilation of the 
sickroom. Boil all water and milk before allowing its use 
by the patient or members of the household. Fumigate the 
room and contents after the patient leaves it. 

What hygienic precautions should be employed about 
diphtheria? 

Isolate the patient ; refuse admission to the sick-room of 
all whose presence is not necessary; attendants should ob- 
serve the greatest personal cleanliness; all secretions should 
be collected upon cloths and burned. All articles should be 
disinfected before being removed from the sick-room. Mem- 
bers of the household should be quarantined. 

Mention six desirable factors in the location of a resort 
for consumptives. 

Equable climate, high altitude, dry atmosphere, pure air, 
abundant sunshine and pine forests are climatic factors for 
consumptives. 

State the accepted belief in respect to the limitation of 
protection from vaccination. 

Five years, when revaccination should be attempted. Dur- 
ing a small-pox epidemic it is advisable to revaccinate all 
individuals who have not been vaccinated within two years. 

Mention some of the adulterations in preparations of 
ground coffee for sale in the shops. 

Chicory, peas, roasted cereals and legumes, date stones, 
acorns, sawdust, etc. 



166 HYGIENE. 

What class of foods should predominate for persons 
over sixty years of age? 

Use eight-tenths the quantity of proteids that the vigorous 
adult requires; seven-tenths the quantity of carbohydrates; 
and one and two-tenths times the quantity of fats. 

Which in your judgment is to be preferred in vaccina= 
tion, animal or humanized lymph, and why? 

Animal lymph, because in its preparation greater care may 
be taken to, secure its freedom from deleterious additions. 

Name some of the nuisances dangerous to health. 

Gases and dust of a poisonous or irritating nature arising 
from many manufacturing industries. Collections of stag- 
nant water, garbage and animal excreta exposed to air ; leak- 
ing drains or sewers saturating the soil, or allowing the escape 
of gases. Industries giving rise to great noise or vibration 
in thickly settled communites. 

What is the best means for preventing the access of 
sewer gas in dwellings? 

Place a trap or water seal between the house drain and the 
sewer and provide an air inlet pipe to open into the drain 
pipe between this trap and the house. A ventilation pipe 
should extend from the house drain to a point above the roof. 

State the ordinary death rate of each of four cities 
having respectively a population of more than fifty thou= 
sand (50,000). 

Dublin, 39.9; St. Petersburg, 31; Berlin, 17; Amsterdam, 

17.8 (1897). 

Name the diseases the predisposition to which is greatly 
increased by the habitual use of alcohol. 

Diseases of the heart and vascular system, the kidneys, 
brain and liver, and of the respiratory system, particularly 
pneumonia and asthma. 



HYGIENE. 167 

Mention methods to be employed for preventing epi= 
demies of yellow fever in the tropics. 

Remove at once to high or new ground should the disease 
appear. Cremate all those who have died of the disease; 
disinfect and remove all filth and endeavor to destroy all 
mosquitoes and their larvae and other insect pests by the 
use of petroleum, sub-soil drainage of damp places, and fill- 
ing all stagnant pools with clean dirt. 

Name four diseases that are communicable to man 
through cows' milk. 

Typhoid fever, scarlet fever, cholera and tuberculosis. 

To what is indigestion from excessive tea drinking 
attributable. State a formula for the preparation of 
good tea. 

The indigestion is caused chiefly by tannin; also by theo- 
bromine. 

Pour one pint of boiling water over a dram of the dried 
tea leaves and allow it to stand without applying further 
heat for five minutes. 

State the advantages of cremation over earth burial. 

Complete destruction of specific disease germs. If crema- 
tion be well performed no obnoxious gases are given to the 
air, no gases of putrefaction contaminate the air, and there 
is no danger of contaminating the water supply through 
drainage from cemeteries. 

What are the respective merits of cotton, wool and silk 
when used as underwear? 

In a variable climate wool is preferable because from a 
larger amount of air enclosed in its texture it acts as a good 
non-conductor of heat, retaining the body temperature. As 
wool is hygroscopic it readily absorbs moisture from which 
it parts slowly, so preventing surface chill of the individual 
by too rapid evaporation. Next in order to retain the heat 



168 HYGIENE. 

of the body we rank silk, and least valuable for the retention 
of body heat is cotton. If it be our purpose to supply a cool 
garment we would of course reverse this order of arrange- 
ment. 

If a chemical analysis of water revealed the presence 
of nitrites and nitrates, would this condemn it for drinking 
purposes? If so, why? 

Yes, particularly if nitrites be present. Organic matter, 
particularly sewage, is converted first into nitrites, and these 
into nitrates through the action of bacteria in the soil. These 
salts would, therefore, indicate a former pollution of the 
water with probably some of that polluted material still in 
the water. If nitrates only are present, and it can be shown 
that the organic matter is of a vegetable origin only, the water 
need not be condemned. 

To what diseases are negroes comparatively insuscep= 
tible? In the Middle States to what diseases are negroes 
more prone than whites? 

Dysentery, yellow fever, and diseases incident to exposure 
to summer heat. Negroes are more prone than whites to 
contract small-pox, diseases of the respiratory tract, fibroid 
tumors, keloid growths and venereal diseases. 

Give a medical and hygienic plan for the inspection of 
immigrants who have just arrived at a seaport. 

Examine the " Bill of Health " and clinical records of all 
cases treated during the voyage and the lists of passengers, 
crew and manifests, and, if desirable, the ship's log. Have 
crew and passengers mustered and compared with the lists, 
investigating any discrepancies and make a careful examina- 
tion of both crew and passengers. If a case of infectious 
disease has occurred during the voyage, disinfect all exposed 
baggage and freight and detain such members of the crew 
and passengers as have been exposed until the incubation 
period of the disease has passed. 



HYGIENE. 169 

What conditions of ill health make residence in high 
altitudes dangerous? Why? 

Chronic Bright 's disease, disease of the heart, emphysema, 
and old age. High altitudes occasion increased respiratory 
effort from the rarined condition of the atmosphere, causing 
increased heart action, and a lessened perspiratory function. 

State the physical conditions that make the practice of 
taking hot baths inadvisable. 

Acute inflammatory diseases, tuberculosis, organic diseases 
of the heart and brain, aneurism, cancer, and all diseases in 
which stimulation of the circulation is to be avoided. 

State some of the sequelae of (a) over=strain, (b) over= 
exertion, (c) over-training. 

(a) Parting of continuity of osseous, ligamentous, muscu- 
lar to blood-vessel structure leading to fractures, dislocations, 
rupture of muscles, hernia, rupture of heart muscle, disease 
of valves of heart or apoplexy. 

(b) May produce same conditions as overstrain and in 
addition cause general muscular relaxation, dyspnea, syn- 
cope, etc. 

(c) Loss of appetite and of muscular power, successive 
crops of boils appear, individual loses mental power, as of 
concentration of thought, and digestive disturbances occur. 

What constitutes hard water and soft water? 

" Hardness is the capacity a water has for decomposing 
soap, and depends on the amount of salts of magnesia and 
calcium in solution. ' ' ( Harrington. ) 

■Soft water contains little or no dissolved salts and rapidly 
forms a lather with soap. 

Mention the dangers of excessive shade about dwellings. 

Excessive shade interferes with the free movement of air, 
prevents penetration of the sun's rays, promotes dampness 
which is given off to the air by evaporation. It exerts a de- 
pressing mental action, promotes the growth of fungi and 



170 HYGIENE. 

bacteria, and prevents the aspirating action of heat from the 
sun upon air and moisture in the soils. 

What is milk sterilization? How is it performed? 

Destruction of micro-organisms in the milk by heat. By 
continuous heating of the milk, under pressure, for two 
hours at 248° F. 

State the objections usually advanced against vaccina= 
tion as a preventive of smalNpox. 

It is urged that it fails to protect from small-pox (which 
is false), that it may produce blood-poisoning, that constitu- 
tional diseases like syphilis, scrofula, etc., may be introduced 
by the vaccine virus, or in the operation. Also that tetanus 
may result, and that it is not right to deliberately inoculate 
a healthy person with the virus of vaccinia or of any disease. 

On what generally accepted theory are toxins used for 
the prevention and cure of disease? 

That their presence in the system renders the blood no 
longer able to support the lives of bacteria that occasion such 
toxins. 

What infectious diseases may be due to impure drink> 
ing water? 

Typhoid fever, malm Ml "fevCT^, 1 cholera, relapsing fever, 
dysentery, parasitic diseases. 

Define humidity of the atmosphere. Why should a 
humid atmosphere cause rheumatic persons and persons 
suffering with the gout increased sensitiveness? 

The term humidity refers to vapor of water in the air. An 
increased humidity increases sensitiveness of gouty and rheu- 
matic patients by decreasing elimination from the skin of 
excretory organic matters and uric acid derivatives and thus 
leading to retention of such poisons in the system. 

What constitutes a thorough meat inspection? How 
should an inspection of milk be conducted? 

Meat should be inspected within 24 hours after the animal 



HYGIENE. 171 

is killed. The following points are noted: The quantity of 
bone, for which 17 to 20 per cent, is to be allowed. The 
quantity and char-acted of the fat, noting its color, consis- 
tency, and taste. Condition of the flesh. Condition of the 
marrow. Examination of the lungs, liver, kidneys for detec- 
tion of infectious disease manifestations. A microscopical 
examination of the flesh for detection of bacteria of path- 
ogenic character, trichina, tape-worm or other parasites. 
Where possible, it is well to investigate the surroundings in 
which the animal has lived and the methods employed for 
storage and refrigeration. 

An inspection of milk takes cognizance of its specific grav- 
ity, color, quantity of cream, presence of preservatives, pres- 
ence or absence of dilution, or addition of coloring matter, 
determination of total solids, of quantity and quality of ash, 
of fats, casein, lactose. The microscopical and bacteriological 
examinations are performed and finally an examination is 
made of the source, storage and distributing methods. 



CHEMISTRY. 



What is chemical affinity? 

Chemical affinity, or chemism, is that force which combines 
atoms to form molecules. 

Mention three fixed monads, two fixed dyads, one fixed 
triad and three elements that vary in valency. Illustrate. 

Monads; hydrogen, chlorine, and bromine. Hydrogen is 
the standard of comparison, chlorine and bromine are shown 
to be monads in their compounds, hydrochloric acid, HC1, 
hydrobromic acid, HBr, etc. In no known compounds will 
these elements combine with more than one hydrogen atom. 

Dyads; oxygen and calcium, as shown in the compounds, 
water, H 2 0, calcium chloride, Ca01 2 . 

Triad; boron, as shown in the oxide, B 2 3 , two atoms of 
boron combining with the three bivalent oxygen atoms. 

Three elements varying in valency are : Carbon, dyad in 
CO, tetrad in C0 2 ; sulphur, tetrad in S0 2 , hexad in S0 3 ; 
gold, monad in AuCl, triad in AuCl 3 . 

Differentiate mechanical divisibility and chemical di= 
visibility. 

Mechanical divisibility, that obtainable by mechanical or 
physical means, permits, theoretically, the division of matter 
into its molecules. 

Chemical divisibility, that obtainable by chemical means, 
permits of the division of matter into its atoms. 

What are salts and how are they formed? Define 
neutral salt, acid salt, double salt. 

Salts are compounds formed from acids by substituting 

(173) 



174 CHEMISTRY. 

metals or basic radicals for part or all of the replaceable 
hydrogen of the acid. 

Neutral salts are those formed from acids by substituting 
metals or basic radicals for all of the replaceable hydrogen of 
the acid. 

Acid salts are those formed from acids by substituting 
metals or basic radicals for part of the replaceable hydrogen 
of the acid. 

Double salts are those containing two different metals or 
basic radicals in their molecule. 

Mention five elements found in nature only in combin= 
ation. Into what groups are elements divided? 

Aluminum, potassium, sodium, chlorine and bromine. 

Elements may be classified according to their electro-chem- 
ical properties, e. g., the electro-negative non-metals, the 
electro-positive metals; they may be classified according to 
their analytical properties, e. g., those precipitated by hydro- 
chloric acid, those precipitated by hydrosulphuric acid, etc.; 
they may be classified according to their atomic weights (the 
periodic law) , thus bringing together in groups 'elements 
similar in properties. 

Mention five elementary substances commonly used in 
medicine in a pure or uncombined state. 

Oxygen, iodine, sulphur, phosphorus, carbon. 

Define reaction, water of crystallization, atomic weight, 
specific gravity, reagent. 

Reaction — the rearrangement of atoms with formation of 
new compounds effected in a chemical change. Water of 
crystallization — water necessary to the crystal form. Atomic 
weight — the relative weight of an atom as compared with 
the weight of another atom taken as a standard. Specific 
gravity — the relative weight of a substance as compared with 
the weight of an equal volume of another substance taken as 
a standard. Reagent — a substance used to produce a 
chemical reaction. 



CHEMISTRY. 175 

Define isomorphous, amorphous, crystalline, galvanic, 
polarization. 

Isomorphous — of the same form, relating in chemistry gen- 
erally to substances which crystallize in the same form. 
Amorphous — without form, substances having no regularity 
of internal structure, not crystalline. Crystalline — substances 
having a regularity of internal molecular structure produc- 
ing under proper conditions definite geometrical forms. Gal- 
vanic — that pertaining to electricity of chemical origin to 
current electricity. Polarization — in reference to light, means 
the breaking up of the light ray into two parts whose planes 
of vibration are at right angles to each other. Polarization 
in electrical batteries refers to the accumulation of gas on the 
plates, thereby interfering with the further production of 
the electric current. 

Describe a method of producing an electric current by 
chemical action. 

In a jar containing water rendered slightly acid with sul- 
phuric acid, place a plate of copper and one of zinc ; connect 
the two plates outside of the liquid by means of a wire and a 
current of electricity will be developed, "flowing" from the 
zinc to the copper through the liquid, and from the copper to 
the zinc through the wire. 

Explain the uses of the spectroscope in chemical analysis. 

A solid body at a white heat produces a "continuous spec- 
trum." Elementary substances in the state of gas or vapor 
when highly heated yield characteristic spectra consisting of 
but one or more bright lines, the position of which is positively 
fixed for each element. If a strong white light be passed 
through certain solutions we obtain a continuous spectrum 
crossed by dark lines — "an absorption spectrum." These 
facts are made use of in the examination of heated vapors 
and of certain solutions. In medicine the spectroscope is 
especially useful in the identification of blood by its absorp- 
tion spectrum. 



176 CHEMISTRY. 

Define sublimation, distillation, static electricity, gal= 
vanic cell, organic compound. 

Sublimation — the vaporization and condensation of a vola- 
tile solid. Distillation — the vaporization and condensation 
of a liquid. Static electricity — that generated by friction. 
A galvanic cell is an arrangement of elements and fluid for 
the production of electricity by chemical action. An organic 
compound is a hydrocarbon or a substance which may be re- 
garded as derived from a hydrocarbon. 

Give the chemical name of each of the following: (a) 
common salt, (b) calomel, (c) sal=ammoniac, (d) plaster of 
Paris, (e) a principal ingredient of baking powder. 

(a) Sodium .chloride, (b) mercurous chloride, (c) ammo- 
nium chloride, (d) calcium sulphate, (e) sodium bicarbonate. 

What is lunar caustic? State how lunar caustic is pre= 
pared. 

Lunar caustic is moulded silver nitrate. To 100 Gm. of 
silver nitrate in a porcelain dish add 4 Gm. of hydrochloric 
acid, and melt the mixture at as low a temperature as pos- 
sible. Stir well and pour the melted mass into suitable 
moulds. 

Write the formulas and the names of five acids, giving 
the graphic formula of one of them. 

Hydrochloric acid, HOI; hydrobromic acid, HBr; nitric 
acid, HN0 3 ; sulphuric acid, H 2 S0 4 ; sulphurous acid, H 2 S0 3 . 

The graphic formula for nitric acid is 

O 

// 
H-O— N 

O 
How may ferric hydrate be hurriedly prepared? When 
and how should ferric hydrate be used as an antidote? 

Ferric hydrate may be prepared by adding ammonia water 
to . a solution of ferric sulphate. Wash the precipitate by 
decantation and filter through unbleached muslin. 



CHEMISTRY. 177 

Ferric hydrate is used as an antidote for arsenic. Give 
freely mixed with water or with milk. 

Give the details of a test for arsenic. 

The Keinsch test : Acidify with hydrochloric acid, introduce 
a strip of pure, clean copper foil and boil. If a gray coating 
form on the copper, remove from the liquid, dry carefully 
by pressing between folds of filter paper, place the copper at 
the bottom of an ignition tube, and heat. If the deposit upon 
the copper be arsenic it will volatilize and will deposit on the 
cool portion of the tube in octahedral crystals of arsenious 
oxide. 

Mention the physical and the chemical properties of 
H 2 S. 

Hydrogen sulphide is a colorless transparent gas, slightly 
heavier than air, of disagreeable odor, soluble in water. It 
is an acid, burns with a blue flame, producing water and sul- 
phur dioxide. Used chiefly as a reagent for the precipitation 
of certain of the heavy metals from their solutions. 

Give the symbol, valence, occurrence in nature, physical 
properties and chemical properties of one of the follo\v= 
ing: bromine, silicon, copper, antimony, manganese. 

Copper, symbol, Cu ; valence II. occurs in nature in the 
free state and as the oxide and sulphide. It is a soft, ductile, 
red metal with a specific gravity of 8.9 atomic weight 63.1. 
It is a good conductor of heat and electricity. In dry air 
it undergoes no change, but in moist air it gradually becomes 
coated with a film of the basic carbonate. Heated in the air 
it oxidizes to CuO. It is soluble in hot mineral acids, and is 
acted upon by many of the vegetable acids. 

Mention the halogens. Why are they so called? Give 
the formulas of three compounds each of which shall con= 
tain a different halogen. 

The halogens are fluorine, chlorine, bromine and iodine. 
The name is derived from the Greek, meaning '"salt pro- 
12 



178 CHEMISTRY. 

ducer, " and was given because of the saline character of 
many of the compounds of these elements. 

NaCl, sodium chloride; KI, potassium iodide; KBr, potas- 
sium bromide. 

State the sources of ammonium compounds. Give the 
composition, the method of preparation and the properties 
of sal=ammoniac. 

Ammonium compounds are derived from the ammoniacal 
liquor from gas works. 

Sal ammoniac is the chloride of ammonium, made by satu- 
rating the ammoniacal liquor with hydrochloric acid, evapo- 
rating the solution to dryness, and subliming the salt pro- 
duced. It is a white crystalline substance, salty in taste, 
odorless, very soluble in water. 

Give a test for (a) ferric compounds, (b) ferrous com= 
pounds. Write the chemical names and the formulas of 
three salts of iron used in medicine. 

(a) Potassium ferrocyanide gives a dark blue precipitate 
(Prussian blue). (b) Potassium ferricyanide gives a dark 
blue precipitate (TurnbuH's blue). 

Ferric chloride, Fe 2 Cl 6 or FeCL ; ferrous carbonate, 
FeC0 3 ; ferrous sulphate, FeS0 4 . 

Give the history, occurrence, preparation, properties 
and medicinal uses of chlorine. 

Discovered by Scheele in 1774, and was long thought to be 
a compound. The name was given to it on account of its 
color. Occurs in nature only in combination, chief com- 
pound, sodium chloride or common salt. Prepared by the 
action of hydrochloric acid on manganese dioxide. Proper- 
ties : a yellowish-green suffocating gas, heavier than air, solu- 
ble in water. Chemically it is an element, symbol, 01, atomic 
weight 35.18. a monad in combining power, and has strong 
affinity for other elements, especially for hydrogen. Chlorine 
is used as a disinfectant and deodorant; its aqueous solution 



CHEMISTRY. 179 

has been used locally in scarlet fever, diphtheria, gangrene 
of the mouth, etc. 

Hydrargyri oxidum flavum may be prepared by pour= 
ing a solution of mercuric chloride into a solution of 
sodium hydrate; give the chemical equation. 

HgCl 2 +2NaOH=HgO+2NaCl+H 2 0. 

Mention the oxides of iron and give the formula of one 
of them. 

Ferrous oxide, ferric oxide, and ferro-ferric or magnetic 
oxide. The formula for ferric oxide is Fe 2 3 . 

Give the common name, formula, properties, prepara= 
tion and uses of zinc sulphate. 

White vitriol, ZnS0 4 , made by dissolving zinc in sulphuric 
acid and then evaporating the solution. A white, crystalline, 
freely soluble salt with metallic taste. It is used as an emetic 
and for its effect upon the nervous system, in chorea, etc., 
in many cutaneous affections in ointment form, as a collyrium 
in aqueous solution, and also for injection in gonorrhoea. 

Give the formula and method of manufacture of po= 
tassium nitrate. 

KNO s . Made by decomposition of sodium nitrate by means 
of potassium carbonate or chloride. 

NaN0 3 +KCl=N:ai01+KN0 3 . 

Give the symbol, atomic weight and valence of five non= 
metals. 

Chlorine, CI, 35.2 (35.18), valence I. Oxygen, 0, 16 
(15.88), valence II. Sulphur, S, 32 (31.83), valence II., 
IV., VI. Carbon, C, 12 (11.91), valence II., IV. Nitrogen, 
N, 14 (13.93), valence III., V. 

Define amid, anilid, radical. 

An amid may be regarded as a substance formed from am- 
monia by substituting one or more acid radicals for one or 
more hvdro^en atoms. 



180 CHEMISTRY. 

An anilid is a derivative of anilin, formed 'by substituting 
acid radicals for hydrogen. 

A radical is am atom or group of atoms forming the basis 
of a series of compounds, but incapable of existing in the 
free state. 

How may lead enter the system and produce chronic 
lead poisoning? Give the diagnosis of lead poisoning and 
mention the chemical antidotes for it. 

Lead may be introduced into the system by the drinking 
of water which has been standing in lead pipes; with food 
which has been in contact with the metal (tin-foil containing 
lead, lead glaze on pottery, etc.) ; by handling of lead com- 
pounds (manufacture of paints, painters, etc.) ; by use of 
hair dye containing lead, etc. In chronic lead poisoning we 
have anemia, colic, obstinate constipation, blue line on the 
gums, "wrist-drop," and palsy. The chemical antidotes are 
the sulphates of sodium and magnesium, dilute sulphuric 
acid, etc. 

Mention the principal products obtained from petroleum 
and describe the properties of one of the products men= 
tioned. 

By fractional distillation we obtain from petroleum the 
petroleum ethers, gasoline, benzin, the napthas, kerosene, 
lubricating oils and paraffin. 

Benzin or benzinum is a transparent colorless liquid of 
characteristic odor, lighter than water, insoluble in water, 
soluble in 6 parts alcohol, and freely soluble in ether, ben- 
zene and oils. Boils at 45° to 60° C, and is highly inflam- 
mable. 

Describe starch. How may starch be recognized chemi= 
cally? What substance is formed when diastase or dilute 
acids act on starch? 

A fine white powder or in irregular, angular masses; in- 
odorous and tasteless, insoluble in cold water or alcohol, 
forming a paste or Whitish jelly when boiled with water. It 



CHEMISTRY. 181 

is recognized chemically by the blue color with iodine test 
solution. 

By the action of diastase starch is converted into maltose 
and dextrin; by the action of dilute acids, into dextrose and 
dextrin. 

Describe the preparation and uses of gun cotton 
(pyroxylin). 

Pyroxylin is made by steeping cotton in a mixture of nitric 
and sulphuric acids, then removing and washing with cold 
water. It is used in making collodium. 

How is collodion prepared? 

Collodion (collodium, U. S. P.) is made by dissolving py- 
roxylin in ether and alcohol. Four grams of pyroxylin with 
75 Cc. ether are allowed to stand 15 minutes and then 25 Cc. 
alcohol are added. 

What is vinegar chemically? Describe the chemical 
changes in the manufacture of vinegar. 

Vinegar is a dilute (about -1 per cent.) solution of acetic 
acid with traces of various vegetable extractives. It is pro- 
duced by the oxidation of alcoholic liquors, wine, eider, etc., 
under the influence of the acetic acid ferment, mycoderma 
aceti. 

C 2 H 5 OH+0 2 =HC 2 H 3 2 +H 2 0. 

What is the chemical treatment of alimentary corrosion, 
caused by mineral acids? Why should the stomach pump 
be used carefully, if at all, in such cases? 

The acid should be neutralized by weak alkalies, preferably 
by magnesia, with the precaution that if carbonates are used 
they must be given slowly and in dilute solution to avoid a 
sudden evolution of gas. The stomach-pump must be used 
only with greatest caution on account of danger of mechanic- 
ally injuring the corroded membranes. 

Give the chemical treatment of phosphorus poisoning. 

Copper sulphate is the chemical antidote. An attempt is 



182 CHEMISTRY. 

made, also, to oxidize the phosphorus, using for this purpose 
hydrogen dioxide, ozone, old oil of turpentine, etc. 

Give the formula and properties of methane and describe 
its preparation. 

Methane, CH 4 , known also as marsh gas, is produced in 
nature by the decomposition of vegetable matter under water. 
It is a light, colorless, odorless, tasteless, inflammable gas. 
Burns with a bluish flame and forms an explosive mixture 
with air. It may be prepared by heating a mixture of sodium 
acetate, sodium hydroxide and lime. Representing the reac- 
tion as taking place between the two sodium compounds we 
have 

NaC 2 H 3 2 +NaOH= CH 4 +Na 2 C0 8 . 

What is an alkaloid? Mention an alkaloid of (a) bella= 
donna, (b) cinchona, (c) hyoscyamus. 

An alkaloid may be described as an organic, nitrogenous 
substance, basic in character, capable of combining directly 
with acids to form salts. 

(a) Atropine, (b) quinine, (c) hyoscy amine. 

Differentiate chemically cane=sugar and grape=sugar. 

Cane sugar, C 12 H 22 1;L , does not reduce Fehling's solution; 
with Trammer's test a blue solution is obtained, but there is 
no reduction on boiling. 

Grape sugar, C 6 H 12 6 , readily reduces both Fehling's and 
Trommer 's solutions. 

Give the symptoms, diagnostic features and treatment 
of phosphorus poisoning. 

Disagreeable taste, thirst, nausea, vomiting, purging, later 
a jaundiced condition and hemorrhages; sometimes neurotic 
symptoms, cramps, etc. A fatty degeneration of the organs 
is produced. Vomited matter may be luminous in the dark. 

Treatment. — Copper sulphate as emetic and chemical anti- 
dote, magnesium sulphate, animal charcoal, dilute hydrogen 
dioxide, old oil of turpentine. 



CHEMISTRY. 183 

Define alcohol. Give the approximate percentage of 
alcohol in (a) light wines, (b) heavy wines, (c) beers, (d) 
whisky, (e) brandy. 

An alcohol may be defined as a compound of a hydrocarbon 
radical with hydroxyl, e. g., ordinary alcohol, C 2 H 5 OH. 

(a) 6 to 12 per cent, (b) 12 to 25 per cent., (c) average of 
4 to 5 per cent., (cl) 30 to 60 per cent., (e) 30 to 50 per cent, 
these percentages being all by volume. 

In a thousand parts of human urine what will be the 
average composition as to (a) water, (b) urea, (c) uric 
acid, (d) organic matters, (e) chloride of sodium, (f) phos- 
phoric acid, (g) potash and lime. 

(a) In 1000 parts by weight of urine there will be about 
980 parts water, (b) about 22 parts, (c) 0.4 part, (d) 25 
parts, (e) 8 parts, (f) 2 parts (P 2 5 ), (g) potash, 2 parts 
(K 2 0), and lime, 0.2 part. 

(The above is a most unusual form of stating urinary com- 
position.) 

How is chloroform (a) prepared, (b) purified, (c) tested 
for impurities? 

(a) Chloroform may be prepared by the action of bleaching 
powder on alcohol, or on acetone, or by the action of an alkali 
on chloral, (b) It is purified by shaking with water and then 
with pure sulphuric acid; it is then agitated with lime and 
with .dry calcium chloride, and finally redistilled, (c) It should 
yield no foreign odor on evaporation. Shaken with water, 
the latter should be neutral to litmus, and should not be 
affected by addition of silver nitrate or of potassium iodide. 
Shaken with one-tenth part strong sulphuric acid, the chloro- 
form should remain colorless and the acid should not be more 
than faintly colored. 

What is the range of the specific gravity of normal 
urine? State what diseased conditions produce (a) an ab= 



184 CHEMISTRY. 

normally high specific gravity of the urine, (b) a low 
specific gravity of the urine. 

The specific gravity varies generally between 1010 and 1030, 
with an average of 1020. 

(a) Diabetes mellitus, acute nephritis, fever, loss of water 
by other excretions. (b) Interstitial nephritis, uremia, 
chronic parenchymatous nephritis, absorption of exudates, etc. 

How is carbolic acid prepared? Give the treatment of 
carbolic acid poisoning. 

Carbolic acid or phenol is prepared from coal-tar by frac- 
tional distillation with subsequent purification, or it is pre- 
pared synthetically from benzene. 

Treatment, — Use stomach tube cautiously, chemical anti- 
dotes are sodium sulphate, magnesium sulphate, dilute acetic 
acid (vinegar), and strong alcoholic drinks. Keep body warm 
and give stimulants. 

Mention a secretion of the body that contains (a) 
cholesterin, (b) pepsin, (c) trypsin, (d) casein, (e) 
bilirubin. 

(a) Bile, (b) gastric juice, (c) pancreatic juice, (d) milk 
( caseinogen) , (e) bile. 

What reaction takes place when chloral hydrate is 
mixed with an alkali? Illustrate. 

Chloroform is produced. 

Chloral, CCLCOH+NaOH^chloroform, CHCl,+sodium 
formate, NaCOOH. 

Give the chemical reaction of (a) saliva, (b) gastric 
juice, (c) tears, (d) bile, (e) blood. 

(a) Alkaline, (b) acid, (c) neutral, (d) alkaline, (e) alka- 
line. 

Give the chemistry of acetic acid; mention the most im= 
portant acetates and give a method of preparing one of 
them. 

Acetic acid, HC 2 H 3 2 , is prepared by the destructive dis- 



CHEMISTRY. 185 

tillation of wood and also by the oxidation of alcohol. It is 
a clear, colorless liquid with characteristic odor. 

Important acetates are acetate of ammonium, iron and 
ammonium, lead, potassium, sodium and zinc. Potassium 
acetate is made 'by neutralizing acetic acid with potassium 
carbonate. 

Give the formula of (a) common (ethyl) alcohol, (b) 
sulphuric ether, (c) acetic acid, 

(a) C 2 H 5 OH. (b) (C 2 H 5 ) 2 0. (c) HC 2 H 3 2 . 

State the non=pathologic causes of abnormal deviations 
in the urinary specific gravity. 

The specific gravity may be increased above the normal 
average by sleep, by exercise, by perspiration ; it may be de- 
creased by drinking of large quantities of liquids, by check- 
ing of perspiration, by chilling the surface of the body, etc. 

What are (a) albuminoids, (b) proteids? Give ex= 
amples of each. 

(a) Albuminoids are substances of modified proteid nature 
characteristic of the supporting tissues of the body, e. g., 
ossein, chondrigen, elastin. 

(b) The term proteid is variously used (1) to signify the 
entire class of carbon, nitrogen, hydrogen, oxygen and sul- 
phur compounds which on decomposition yield ammonium 
compounds, amides, amido acids, etc., including the albumins 
and globulins, the derived substances, peptone, etc., the com- 
pound protein substances, mucin, hemoglobin, etc., and the 
albuminoids. (2) It is sometimes used to represent the albu- 
mins and the derived and compound albumins, excluding the 
albuminoids. (3) It is sometimes used to represent the com- 
pound albumins alone, mucin, hemoglobin, etc. 

Mention four alkaloids of opium. 

Morphine, narcotine, papaverine and codeine. 

What is the source of uric acid in the economy? Give 



186 CHEMISTRY. 

the formula and properties of uric acid and mention its 
chemical tests. 

Uric acid is derived in part from the nucleins of the body 
tissues and in part from similar bodies taken in food. It 
has the formula C 5 H 4 N 4 3 , and, when pure, is a colorless, 
crystalline, odorless, tasteless powder, very insoluble in cold 
water or in most acids, in alcohol or in ether. Soluble in 
sulphuric acid and in solutions of many of the alkaline salts. 

The murexid test. — Moisten with nitric acid, evaporate to 
dryness, moisten the residue with ammonium hydroxide — a 
purple-red color is obtained. The silver carbonate test. — 
Render the urine alkaline with sodium carbonate, moisten a 
filter paper with the liquid and touch the moist paper with 
a glass rod carrying a drop of silver nitrate. A gray stain 
indicates presence of uric acid. 

How do human milk and cow's milk differ? What 
chemical changes take place in milk when it is exposed to 
atmospheric influences. 

Human milk contains rather less total solids, less proteids, 
more sugar, and less salts than cow's milk. The fat is about 
the same. 

On exposure to air, bacteria are taken up by the milk, and 
under the influence of the bacterium lactis lactose is changed 
to lactic acid. This produces a separation of a precipitate 
of caseinogen (curd). As a result of further decomposition 
the lactic acid is changed to butyric acid, which may be recog- 
nized by its odor. 

State the general composition of fats and give the chief 
constituents of (a) tallow, (b) butter, (c) olive oil. 

Fats are compounds of the radical glyceryl (C 3 H 5 ) with 
the higher acids of the first and second series of hydrocarbons ; 
most abundantly we find the glycerides of palmitic, stearic 
and oleic acids. 

(a) Tallow is characterized chiefly by stearin, the glyoeride 
of stearic acid; (b) butter is characterized by a larger per- 



CHEMISTRY. 187 

centage of the glycerides of the more volatile acids, butyric, 
caproic, caprylic. etc.; (c) olive oil is a glyceride of oleic and 
palmitic acids with arachnidin and cholesterol. 

Give the composition and properties of urea. 

Urea, CO(NH 2 ) 2 , is the chief nitrogenous excrement of 
mammals. It is a crystalline substance very soluble in water, 
less soluble in alcohol, insoluble in ether. 

What is the usual composition of urinary calculi? Give 
the test for recognizing the principal ingredient. 

Uric acid and urates, calcium, magnesium and ammonium 
phosphates, and calcium oxalate. Uric acid is frequently the 
nucleus about which a calculus builds itself, and may there- 
fore be regarded as "the principal ingredient.'' The test 
for uric acid is the murexid test: Evaporate with a drop of 
nitric acid and moisten the residue with ammonium hydroxide. 
A purple-red color indicates uric acid (or urates). 

What chemical reaction takes place when H 2 2 is ap= 
plied to sloughing wounds? 

It acts as an oxidizing agent, giving off an atom of nascent 
oxygen which attacks dead tissue, pus, etc. The decomposi- 
tion of the hydrogen dioxide is accompanied by effervescence. 

What is hemoglobin? Name some of its properties and 
give a chemical test for it. 

Hemoglobin is a compound of an iron-holding radical, 
hemochromogen (hema tin), with an albuminous radical, globin. 
To it the blood owes its color. It combines readily with oxy- 
gen, forming oxyhemoglobin, by which oxygen is carried to 
the tissues. Various derivatives of hemoglobin may be pro- 
duced by action of reducing agents, etc., and many of the 
body pigments are derived therefrom. Hemoglobin may be 
recognized by the guaiacum test : To the fluid add 3-4 drops 
of freshly prepared tincture of guaiacum resin ; float an 
etherial solution of hydrogen dioxide on the surface of the 
mixture — in presence of hemoglobin a blue color will develop. 



188 CHEMISTRY. 

Or the "hemin" test may be used: To a drop of blood on a 
glass slide add a minute crystal of sodium chloride and two 
drops of glacial acetic acid and heat slowly to boiling. Cool 
and examine under the microscope for crystals of hematin 
hydrochloride. 

When testing for albumin in urine, how do you deter= 
mine between it and other coagulable proteids? 

The only proteids coagulated by heat are albumin and 
globulin;* of these albumin is soluble in pure water; globulin 
is not. Add the urine drop by drop to some clear water in 
a test-tube ; if globulin be present a cloud will form as each 
drop sinks through the water. Globulin may be separated 
from albumin by saturation with magnesium sulphate; glo- 
bulin is precipitated, albumin is not. 

When testing for glycosuria with Fehling's solution 
how do you determine whether the reaction is that of 
sugar or some other reducing agent? 

By applying the fermentation test with yeast, the glucose 
of diabetic urine ferments readily, while glycuronic acid and 
other reducing substances which may be present do not fer- 
ment. 

State the conditions favorable to crystallization. 

That the molecules shall be free to move, as they are when 
the substance is in fluid condition. The substance is melted 
and slowly cooled, or dissolved 1 in a suitable solvent and then 
slowly evaporated. 

What temperature Fahrenheit is equivalent to a tem= 
perature of 28 degrees centigrade? What temperature 
centigrade is equivalent to a temperature of 120 degrees 
Fahrenheit? 

28 degrees C. X V 5 = 50.4 plus 32 equals 82.4 Fahr. 
120 degrees Fahrenheit minus 32 equals 88 X 5 4 equals 
48.8 C. 



CHEMISTRY. 189 

Define atom, molecule. 

The atom is the smallest particle into which matter can be 
divided. 

A molecule is the smallest particle into which matter can 
be divided without altering its characteristic properties. 

Give the names of two elements or radicals in each of 
the following groups: 

Univalent. Bivalent. Trivalent. Quadrivalent. 

Hydrogen. Oxygen. Boron Carbon. 

Chlorine. Sulphate S0 4 . Aurum. Platinum. 

Illustrate the comparative significance of the following 
affixes: ous, ic, ite, ate, id. 

An oxy-acid of stable composition, or one of great import- 
ance to arts and industries, takes the termination ic, as H 2 S0 4 , 
sulphuric acid. 

If an oxy-acid of the same elements contains less oxygen in 
its molecule it terminates in ous, as H 2 S0 3 . sulphurous acid. 

The terminations ous and ic may be used also to distinguish 
between different combinations (not acid) of the same ele- 
ments, the ous indicating the lower valence (real or apparent) 
of the positive element, e. g., ferrous sulphate. FeS0 4 ; ferric 
sulphate, Fe 2 (SOJ 3 . 

Salts formed by replacing the hydrogen of an ic acid by a 
metal or basic radical have their names terminating in ate, 
as ZnS0 4 , zinc sulphate. 

Salts formed by replacing the hydrogen of an ous acid have 
their names ending in ite, as Na 2 S0 3 , sodium sulphite. 

Salts of hydra cids have the termination id (or ide). 

Compare ozone with oxygen as to (a) occurrence, (b) 
properties. 

(a) Ozone is found in air only under exceptional circum- 
stances, or in minute quantities. 

Oxygen occurs in all atmospheric air in the proportion of 
about 23 per cent, by weight. 

(b) Ozone is a very energetic oxidizing agent, acting like 



190 CHEMISTRY. 

nascent oxygen, and oxidizing substances that resist the action 
of ordinary oxygen, as silver. 

Ozone will not support respiration, acting as an irritant to 
respiratory membranes. 

Ozone supports combustion more vigorously than oxygen. 

State the characteristics of the following mineral 
waters: Chalybeate waters, bitter waters, sulphur waters, 
effervescent waters, cathartic waters. 

A chalybeate water is a mineral water containing dissolved 
salts of iron, usually basic carbonates. It has a slight tonic 
action, but may occasion intestinal and stomach disturbance 
from its irritant action. 

Bitter waters may owe their bitter properties to Epsom 
or Glauber's salts, held in solution, when they exert a laxa- 
tive action ; or a natural water may be bitter from its contact 
with vegetable substances, acquiring thereby tonic and stom- 
achic properties. 

Sulphur waters are those containing dissolved alkaline sul- 
phides, or poly-sulphides, or H 2 S. Such waters exert an 
alterative and often slightly laxative effect, and have a certain 
value in treating diseases of the skin. The greater value of 
sulphur waters is found in their use for bathing, in chronic 
cutaneous affections, in gout, in rheumatism. 

Effervescent waters are such as are strongly charged with 
C0 2 gas. Such waters are useful as sedative and slightly 
stimulating beverages, e. g., the use of plain soda water in 
allaying vomiting. 

Cathartic waters are such as contain eathartic or laxative 
salts in solution, e. g., Epsom salts, magnesium sulphate, and 
Glauber's salts, sodium sulphate. Their effect is not only 
that of a cathartic, they may assist elimination from other 
channels, as kidneys, skin, etc. 

What is the antidote for nitric acid poisoning? 

Oxide of magnesium, commonly called calcined magnesia. 
Alkaline carbonates, soap, albumin, oils. 



CHEMISTRY. 191 

Describe the preparation of iodide of potassium. Give 
the reaction. 

Saturate a strong solution of caustic potash in water with 
iodine. Evaporate to dryness — a mixture of iodide and 
iodate of potassium is formed, and when this is heated 
strongly the iodate of potassium parts with its oxygen. Dis- 
solve the resultant mass in water, and from it will crystal- 
lize, on evaporation, cubes of potassium iodide. 

6KHO + 3I 2 = SKI + KI0 3 + 3H 2 ; 

Then 2KI0 3 + heat = 2KI + 30 2 . 

Describe lithium as to (a) occurrence, (b) salts com= 
monly used in medicine, (c) chemistry of its use in so= 
called rheumatic affections. 

(a) Lithium occurs in the mineral silicates and phosphates, 
and as chloride and carbonate in mineral waters, (b) Salts 
used in medicine : 

Bromide of lithium LiBr Carbonate of lithium Li 2 C0 3 

Benzoate of lithium LiC 7 H 5 2 Citrate of lithium Li 3 C 6 H 5 7 

Salicylate of lithium LiC 7 H 5 3 

( c) It is stated that 25 parts of carbonate of lithium will 
dissolve one thousand parts uric acid at 100.4° Fahr. ; it is 
administered, therefore, in gout to diminish deposits of uric 
acid, and to dissolve uric acid calculi. 

Mention the important physical, physiologic and chem= 
ical properties of ptomains. 

Ptomains are alkaloidal substances produced by the action 
of bacteria on decomposing animal and vegetable matter. 
They resemble the vegetable alkaloids in composition, and 
in their tests, are basic in character, and like alkaloids may be 
poisonous or non-poisonous. 

In their poisonous action, after a period of incubation of 
from two to six hours, there is produced severe gastro-intes- 
tinal irritation with great prostration. 



192 CHEMISTRY. 

What are the chemical constituents of normal urine? 
Give a test for the recognition of albumin in urine. 

Chlorides of calcium, magnesium, sodium, potassium. 
Phosphates of calcium, magnesium, sodium, potassium. Sul- 
phates of sodium, potassium and organic sulphates, indican, 
etc. Coloring matters, including urobilin, urochrome, uro- 
erythrin. Urea, uric acid (as urates), creatinine, hippuric 
acid. 

Boil the urine; if it becomes hazy, or a coagulum forms, 
add a few drops of nitric acid, when, if the urine does not 
become perfectly transparent, albumin is present. 

State the principle underlying the use of antitoxins for 
the prevention or cure of disease. 

Antitoxins are found in the blood serum of animals that 
have recovered from an infectious disease, and when this 
serum is injected into other animals, or man, it confers, on 
its absorption, immunity from that disease. 

How may water be decomposed? Illustrate. 

By passing a current of galvanic electricity through water, 
when the hydrogen gas collects in bubbles at the negative 
electrode and the oxygen gas at the positive electrode ; or by 
passing steam or vaporous water through an iron pipe heated 
to redness, when the hydrogen gas issues at the distal end 
of the pipe and oxygen is retained in chemical union with 
the iron, coating the pipe with Fe 3 4 . 

Define and give examples of the three varieties of 
attraction. 

Attraction of gravitation is the force operating between 
masses of matter, e. g., the attractive force exerted between 
sun and earth. 

Heterogeneous attraction or adhesion refers to surface at- 
traction of unlike substances ; thus water adheres to wood. 

Homogeneous attraction or cohesion is the force uniting 
like substances, and operates in the interior of the mass as 



CHEMISTRY. 193 

well as at the surface; thus cohesion aggregates the mole- 
cules of water into visible drops. 

How many grams are there in a hectogram? How 
many scruples are contained in one pound? 

One hundred grams equal one hectogram. 
Two hundred and eighty-eight (288) scruples one pound 
troy. 

What is the test for the presence of silver, of mercury? 

In solution: Silver with hydrochloric acid or with soluble 
chlorides yields a white precipitate, soluble in ammonium 
hydroxide, insoluble in nitric acid. 

Mercury as mercurosum, in solution, gives a white precipi- 
tate with the same reagents, of mercurous chloride, not dis- 
solving, but turned black on addition of ammonium hydroxide. 

Mercury as mercuricum, gives no precipitate with hydro- 
chloric acid, but gives a white precipitate with ammonium 
hydroxide and a scarlet precipitate with potassium iodide. 

How much water vapor will be formed by the union of 
500 cubic centimeters of hydrogen and 250 cubic centi= 
meters of oxygen? 

Five hundred cubic centimeters, at standard temperature 
and pressure. 

What is a graphic formula? Give five illustrations. 

A graphic formula is one showing something of the manner 
in which the atoms are joined or arranged within the molecule. 

H O 





Acetic acid. 


1 // 
H— C— C-0— H ' 

H 


H— 0— H 


Water. 


H — S — H Hydrogen sulphide. 


NEI 


Ammonia. 


H 

! 

H C H Marsh gas. 

H 



13 



194 CHEMISTRY. 

Give the atomic weight, atomic volume, molecular 
weight, molecular volume, and density of oxygen. 

Atomic weight, 16 (15.88); atomic volume, 1; molecular 
weight, 32; molecular volume, 2; specific gravity compared 
with air, 1.1056; specific gravity, or density, compared with 
hydrogen, 15.88. 

Describe the preparation of sulphur and name the 
oxides of sulphur. 

Prepared generally from the native crude sulphur found, 
in volcanic regions, by distilling from the non-volatile im- 
purities. 

The oxides are the dioxide, S0 2 , the trioxide, SO., the ses- 
quioxide, S 2 3 , and the peroxide, S 2 7 . 

What is Marsh's test? Describe the appartus em= 
ployed, and give the conduct of the experiment. 

Test for detection of arsenic. 

Through the stopper of a glass flask pass : 

1. A safety funnel, the lower end reaching to bottom of 
flask. 

2. An outlet tube of glass. To this is to be fitted (a) a 
tube bent at right angle, lower pant dipping into a solution 
of AgN0 3 . (b) A tube bent at right angle so placed that 
the far part of the tube, drawn out to a jet, shall point 
upwards. 

Test : Place chemically pure zinc in flask, cover with dilute 
sulphuric acid, C. P., in such quantity as will come above 
lower end of safety funnel. 

Hydrogen gas is evolved. Allow gas to pass from the out- 
let tube, to which attach tube (a), the lower end of which is 
immersed in nitrate of silver solution. 

Heat the outlet tube at a point between flask and silver 
solution. At expiration of half hour should there be no brown 
or gray-black stain found on outlet tube where heated, or no 
precipitate (black) found in silver solution, and no yellow 
precipitate formed when to a little of silver solution is added 



CHEMISTRY. 195 

ammonium hydroxide, the zinc and acid used are free from 
arsenic. 

Pour into safety funnel the solution suspected to contain 
arsenic, when, should arsenic be present, a black stain forms 
on outlet tube, a black precipitate appears in silver solution, 
and this solution yields yellow precipitate of arsenite of silver 
when to it we add ammonium hydroxide. 

Now substitute tube (b) for tube (a) ; ignite the gas, a 
whitish flame appears ; if much arsenic, a garlic odor or white 
halo surrounds flame. 

Hold cold white surface, as piece of porcelain, in flame — a 
brown or black stain of metallic character readily dissolving 
in solution of chlorinated lime or chlorinated soda, indicates 
presence of arsenic. 

What is olefiant gas? Name some of its properties. 

Olefiant gas, or ethylene, C 2 H 4 , heavy carburetted hydrogen. 

A colorless gas, feeble ethereal, slightly pungent odor, den- 
sity 14 compared with hydrogen. Almost insoluble in water. 

Can be liquefied, and is then used to produce low tempera- 
ture on its evaporation. Is inflammable, burning in air with 
brilliant flame, forms an explosive mixture with air or oxygen. 
It is largely to the presence of this gas that illuminating gas 
yields light. 

What is meant by the destructive distillation of wood, 
and what are some of the principal products of such a 
process? 

Heating wood in a retort in absence of air and collecting 
and cooling resultant vapors. 

Methyl alcohol, pyroligneous acid, acetic acid, creosote, 
carbolic acid, etc. 

Name and differentiate the three classes of sugars. 

Monosacoharids or glucoses, with the formula, C 6 H 12 6 ; 
disaccharids or sucroses, C 12 H 22 1:L ; polysaccharids or amy- 
loses, (C 6 H-, O.-) n . Chemically the glucoses are aldehydes 



196 CHEMISTRY. 

and ketones, the amylases and sucroses are anhydrides of the 
glucoses. 

What is acetous fermentation? 

Brought about by presence of the mycoderma aceti, it 
causes the souring of alcoholic liquors. It practically con- 
sists in the oxidation of alcohol, producing acetic acid. 
C 2 H 5 OH + 2 = C 2 H 4 2 + H 2 0. 

How are chlorides chemically recognized in urinalysis? 

By their yielding a white precipitate of chloride of silver 
on the addition of a solution of silver nitrate to the urine 
after acidifying with nitric acid. 

Complete the following equation and write the name 
of each resulting compound under its formula: 

C 2 HC1 3 + NaOH = 

C 2 HC1 3 + NaHO = CHC1 3 + NaCH0 2 

Chloral. Chloroform sodium formate. 

Pb(N0 3 ) 2 + K 2 O0 4 = 

Pb(N0 3 ) 2 + K 2 Cr0 4 = Pb€r0 4 + 2KN0 3 

Lead chromate potassium nitrate. 
Describe two experiments showing the difference be= 
tween chemical and mechanical action. 

Mix 32 grains sulphur and 56 grains iron filings; a magnet, 
will remove all of the iron, or carbon disulphide will dis- 
solve all of the sulphur. This mixing of sulphur and iron is a 
mechanical act, in which iron and sulphur still preserve their 
properties. Apply heat to such a mixture; a temperature 
much higher than the degree of heat applied will develop, due 
to chemical union of sulphur and iron, and a magnet will no 
longer attract the iron, nor will carbon disulphide have solvent 
action. This is a chemical action resulting in formation of 
a new substance, iron sulphide, in which the properties of iron 
and sulphur no longer exist. 

Dissolve sugar in water. No heat is evolved ; each drop of 
water shows characteristic sweetness of sugar; has been no 



CHEMISTRY. 197 

chemical change, but a physical or mechanical one. Dissolve 
sugar in sulphuric acid, obtain black liquid containing no 
characteristic sweetness; sugar has entirely disappeared. This 
experiment is an illustration of chemical action. 

If potassium be thrown on water, what is the name and 
formula of the resulting compound? 

Potassium hydroxide, KOH. 

What are the general methods by which crystals may 
be obtained? 

Evaporation from solution, solidification after fusion, and 
by sublimation. 

Discuss arsenic and mention its properties, uses and 
compounds. 

Arsenic, symbol As, atomic weight 74.4, valence III., V., 
found in nature chiefly as sulphide, associated with the sul- 
phides of zinc, iron, bismuth, etc. The metal is steel-gray, 
generally crystalline, with a metallic lustre. Used in pyro- 
techny, in making shot, and in pigments. 

Forms a compound with hydrogen, AsH 3 , a very poisonous 
gas. With oxygen it forms the trioxide, As 2 3 , and the 
pentoxide, As 2 5 , the first named being the most important 
compound, often receiving the name of arsenic. It occurs in 
a heavy white powder, or transparent vitreous, or opaque, 
porcelain-like masses slightly soluble in water. 

Other compounds recognized by the pharmacopoeia are the 
iodide, sodium arsenate, and potassium arsenite, the latter 
being a constituent of Fowler's solution. 

The arsenical compounds are used as alterative tonics in 
phthisis, malarial cachexia, cancer pastes, skin diseases, in 
dentistry, etc. 

What is an anesthetic? 

A substance used to produce partial or complete uncon- 
sciousness, and thus allay pain of operative procedures and 
produce muscular relaxation. 



198 CHEMISTRY. 

How much water would be required to yield ioo grams 
of hydrogen? 

Nine hundred grams of water would yield 100 grams hy- 
drogen. 

Compare the physical properties of chlorine, bromine, 
iodine and fluorine. 

Chlorine, a heavy green gas; 'bromine, ia heavy dark red 
volatile liquid; iodine, scale-like blue-black volatile solid; 
fluorine, a light yellow practically colorless gas. 

All dissolve in water in varying degrees. Bromine yields 
orange-colored vapor ; iodine, violet vapor. 

Define evaporation, filtration. 

Evaporation is the conversion of a volatile liquid into a 
vapor. This process takes place at all temperatures. 

Filtration is the act of passing a liquid through a porous 
material, the solid suspended matters being retained. 

Name the constituents of the atmosphere. Give the 
composition by weight and by volume. 

Weight. Volume. 

Oxygen 23 20.93 

Nitrogen 77 79.07 

Water vapor, .5 to 1.4. Carbon dioxide, .04. 

Traces of ammonia and other nitrogen compounds. 

Several rare gases, argon, etc., of which but little is known. 

Name bodily conditions effecting an increase in the 
elimination of urine and also those producing a decrease. 

In health urine is increased in amount where from any 
cause the perspiratory function or alvine discharges are less- 
ened, as from chill of the surface, cold bathing, etc. The 
ingestion of much fluid, as drink or watery foods. In health 
urine is decreased by excessive perspiration, diarrhoea, etc. 

In disease urine is increased in diabetes mellitus, in chronic 
inflammation of kidneys, etc. Often at crisis of a severe dis- 
ease, in hysteria and in other nervous disorders. In disease 



CHEMISTRY. 199 

urine is decreased when by high fever, in acute inflammation 
of kidneys, and in severe infectious diseases. 

Name three common kinds of spirituous liquors and de= 
scribe their manufacture. 

Spirituous liquors are divided into three classes, (a) dis- 
tilled, including whisky, brandy, etc.; (b) fermented, includ- 
ing wines; and (c) malt liquors, including the beers. 

The distilled spirits are made by distilling fermented 
liquors; brandy from wine, whisky from corn or rye or other 
grain, rum from molasses, etc. The wines are made by fer- 
menting grape and other fruit juices. The beers are made 
by fermenting an infusion of malted barley- and hops. 

Give the chemistry of photography. 

A plate is prepared with an emulsion of a silver salt in 
gelatine, and on exposure to light this silver salt undergoes 
reduction. After exposure the plate is treated with a "de- 
veloper" by. which the reduced silver salt is still further re- 
duced, to the metal, and the remaining silver salt is then re- 
moved by washing in a solution of sodium hyposulphite. 
From this negative placed upon a paper prepared in much 
the same manner as the plate the prints are obtained. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

Oa(OH) 2 + C0 2 = OaC0 3 + H 2 

Calcium carbonate water. 

NaC 2 H 3 2 + NaOH = CH 4 + Na 2 C0 3 

Marsh gas sodium carbonate. 
What is meant by atomic weight? 

The atomic weight of an element is the relative weight of 
its atom as compared with the weight of an atom of hydrogen. 

Explain the difference between a solid and a liquid. 

In a solid cohesion binds the molecules so closely together 
that they have no freedom of movement; the substance pre- 
serves a fixed form. 



200 CHEMISTRY. 

A liquid has its molecules less tightly bound together, so 
that they may flow readily. Cohesion and repellent force 
are about equal A liquid has no fixed form, save that of the 
containing vessel. 

What is a gas? 

The molecules making up a gas are self-repellent, each 
molecule striving to pass as far from its neighbors as possible. 
The repellent force of heat has overcome the force of cohesion. 

What is water chemically considered? 

Water is the monoxide of hydrogen. Its composition by 
weight, 18 pounds of water contains 2 pounds of hydrogen 
and 16 pounds of oxygen. By volume two quarts of water 
vapor contain two quarts of hydrogen and one quart of 
oxygen. Water may act as an electro-positive or basic body, 
as in its union with S0 3 , to form H 2 S0 4 . Or it may act as an 
electro-negative or acidulous body, as in its union with K 2 0, 
to form 2KHO. 

How would you determine the specific gravity of a 
liquid? 

Use a hydrometer : An instrument of glass, cylindrical in 
shape, weighted below, and terminating above in an upright 
stem, upon which are engraved lines indicating degrees. 

Place this instrument in the liquid to be examined, and 
note to which mark or degree the instrument sinks. This 
degree denotes the specific gravity of the liquid compared 
with water. 

What is organic chemistry? 

The chemistry of the hydrocarbons and their derivatives. 

What is the purpose of litmus paper in urinalysis? 

For determining if the urine be acid, alkaline or neutral 
in reaction, also whether the acidity be marked or slight, and 
whether the alkalinity be of fixed or volatile character. 

How is excess of uric acid shown in the urine? 

By a ring of whitish color forming above the point of con- 



CHEMISTRY. 201 

tact in the urine when urine is floated on nitric acid in a 
test-tube; such ring disappears when gently heated. 

What effect is produced in mixing air with a blast flame 
as practiced with an ordinary blow=pipe? 

The air so dilutes the gas as to bring every particle of the 
gas in complete contact with the oxygen of the air, thus occa- 
sioning perfect and complete combustion of the gas. The air 
also directs the flame to a desired point. 

What metallic element is constantly present in the col- 
oring matter of the blood? 

Iron. 

Explain the process of combustion. 

Combustion is chemical union taking place between two or 
more substances, accompanied by the evolution of heat and 
light. 

Name the lightest of all known elements. 

Hydrogen. 

Give the symbols of antimony, silver, gold, iron and 
zinc. 

Antimony, Sb ; silver, Ag ; gold, Au ; iron, Fe ; zinc, Zn. 

How would you prepare hydrogen? 

Place zinc in a flask provided with a safety funnel, the 
lower end of which reaches to the bottom of the flask. 
Through a second opening in the stopper of the flask 
pass an exit tube, the lower end of which just enters the 
flask. Then pour into the flask through the funnel dilute 
sulphuric acid. Hydrogen gas is formed, and escapes through 
the exit tube. 

What acid contains chlorine as an important element? 

Hydrochloric acid, HC1. 

How does wine differ chemically from brandy? 

Wine contains from 6 per cent, to 25 per cent, of alcohol; 



202 CHEMISTRY. 

brandy from 30 per cent, to 50 per cent, Wine is a product 
of fermentation of fruit juices; brandy results from distill- 
ing the fermented product of fruit juices. Wine contains a 
number of compound volatile ethers that are not present in 
brandy. 

What is the substance (or substances) from which ordi= 
nary alcohol is derived? 

Potato starch and grains. 

What element constitutes four=fifths of the air? 

Nitrogen. 

Explain the principle of the Bunsen burner. 

The Bunsen burner is supplied near its base with aper- 
tures for the ready admission of air and its mixture with the 
gas. Each particle of gas is thus supplied with sufficient 
air to obtain perfect combustion. 

What is the essential element of all acids? 

Hydrogen. 

Name three elements in the potassium group. 

Potassium, sodium, lithium. 

Is sulphurous acid a solid, a liquid or a gas at ordinary 
temperature? 

It is a liquid resulting when S0 2 is dissolved in water. 

What is albumin? 

It is a complex, colloidal, protedd body composed of H, C, 
0, N, and S, occurring in both vegetable and animal struct- 
ures. 

Name the principal sources of bromine. 

Natural mineral waters containing magnesium bromide in 
solution, and sea water. 

Give the name and formula of a compound of sulphur 
and hydrogen. 

Hydrogen sulphide, H 2 S. 



CHEMISTRY. 203 

What is the meaning of the sesqui in chemical nomen= 
clature? 

It means one and a half, and refers ito the ratio between 
combining elements. Example : Fe 2 3 , sesqui-oxide of iron. 

Where does potassium occur? 

In rocks, soil, etc., in form of silicates, and in sea water, etc., 
in form of chlorides and sulphates. 

Define and give an example of each of the following: 
(a) Binary compound, (b) acid, (c) hydrate, (d) salt. 

(a) A compound containing two elements, as AgCl. (b) 
An acid is a salt of hydrogen; it has a sour taste, turns lit- 
mus red, has corrosive action, when concentrated, upon tis- 
sues, unites with and neutralizes bases, forming salts and 
water. Example, nitric acid, HN0 3 . (c) A hydrate is a com- 
pound of a metal or basic radical with hydroxy!, OH. Ex- 
ample, potassium hydrate, KOH. (d) A salt is a substance 
formed by the replacement of all or part of the hydrogen of 
an acid by a metal or basic radical. Example, potassium 
sulphate, K 2 S0 4 . 

What are the laws governing combination of elements? 

1. All chemical compounds are definite in their composi- 
tion ; the ratio of the elements forming them is constant. 

2. If one element unites with another in more than one 
proportion, such proportions will be multiples or sub multiples 
of each other. 

3. The proportion by weight in which any two elements 
will unite with a third element represents that proportion in 
which they would unite with each other if they could so 
combine. 

What is a chemical reagent? 

A substance having an active chemical effect upon other 
chemical substances. A substance which by its contact with 
another substance creates new compounds. 



204 CHEMISTRY. 

Mention a pentad element and explain the name. 

Nitrogen. 

A pentad element is one the atom of which requires five 
monad atoms to fully satisfy its capacity for chemical union. 

Explain the terms (a) amorphous, (b) alkali, (c) water 
of crystallization, (d) nascent state. 

(a) Amorphous means without form, non-crystalline, (b) 
Alkali, a body possessing the strongest of basic or electro- 
positive properties, usually referring to oxides and hydroxides 
of alkali metals or metals of the alkaline earths, (c) Water 
of crystallization is water necessary to the crystal form, (d) 
Nascent state, or newly born, refers to matter in its atomic 
form, or before the individual atoms freed from a compound 
have united to form molecules. 

What are the properties and uses of glucose? 

A white or yellowish-white, sweetish substance, freely sol- 
uble in water, possessing not quite the sweetening power of 
cane-sugar. Glucose is found in fruits, in honey, and in 
small amount in the various fluids of the body. It is made 
from cornstarch by treatment with dilute acids. It has food 
value and is used as a substitute for cane-sugar. 

What is the difference between nitric oxide (NO) and 
air? 

Nitric oxide is a compound of nitrogen and oxygen, air is 
a mixture of the same elements. 

Give equation for the production of ammonia from am= 
monium chloride and calcium hydroxide. 

2NH 4 C1 + Oa(OH) 2 = 2NH 3 + 2H 2 + CaCl 2 . 

How was salicylic acid originally derived? How is it 
now manufactured? What are its properties? 

It was originally obtained from oil of gaultheria. It is now 
manufactured by passing 00 2 into a heated retort containing 
sodium carbolate, C 6 H 5 ONa+00 2 =C 6 H 4 (OH)OO.ONa, and 
decomposing this sodium salt with HC1. 



CHEMISTRY. 205 

It occurs in fine white needle-shaped crystals, permanent in 
air, of sweetish taste, acid reaction, soluble in 450 parts of 
cold water, soluble in 2 parts alcohol; solution produces in- 
tense violet color with ferric salts. 

Used as a food preservative, is antiseptic and antirheumatic. 

Describe the method of preparing H by the action of Na 
on HoO. Write the formula for the reaction and find how 
many grams of H 82 grams of Na would make by this 
process. (The atomic weight of H is 1, of O 16, of Na 23.) 

Place a piece of clean-scraped sodium in a combustion 
spoon and cover it with a cage of gauze wire to hold it in 
place. Fill a cylindrical glass jar completely full of water 
and invert mouth down in the pneumatic trough. 

Plunge combustion spoon containing Na quickly under 
water, below the mouth of the glass jar; the Na at once de- 
composes water, and bubbles of hydrogen gas rise in the jar. 

Na + H 2 = NaOH + H 

23 + 18 = 40 + 1 

23 grams of Na = 1 gram H 

23 :1 ::82 : X = 3.565 + of H. 

Give a brief description of three experiments illustrat= 
ing the properties of oxygen. 

Plunge a smouldering piece of charcoal in a jar of oxygen 
and the charcoal kindles, burning brilliantly. 

Heat a watch spring at one end until red-hot, then plunge 
into jar of oxygen, and .the steel spring burns with great 
brilliancy. 

Place a piece of phosphorus in a test-tube, cover it with 
water, warm slightly, and then by means of a long glass tube 
direct a jet of oxygen upon the phosphorus; the latter will 
catch fire, burning beneath the surface of the water. 

What is the source of phenacetin? 

It is an anilid, made from anilin, a product of coal-tar. 



206 CHEMISTRY. 

Give the occurrence in nature of phosphorus; of chlorine. 

Phosphorus occurs in nature as phosphate of calcium in 
the mineral apatite, and as phosphate of calcium and of mag- 
nesium in bones. Chlorine occurs in nature chemically com- 
bined with metals, as NaCl, AgCl, etc. As NaCl it is found 
in sea water, river water, and in most natural waters, in 
mineral deposits, as rock salt, and in the tissues and fluids of 
animals and plants. 

What are the chemical names of (a) borax, (b) marble, 
(c) blue vitriol? 

(a) Sodium tetra-borate, or sodium pyro-borate. (b) Cal- 
cium carbonate, (c) Copper sulphate. 

Define positive element, negative element. Illustrate 
each. 

A positive element is one which, on the decomposition of 
a compound by electrolysis, will go to the negative electrode. 

A negative element is one which, on the decomposition of 
a compound by electrolysis will go to the positive electrode. 

Iron, gold and hydrogen are positive elements. Oxygen, 
sulphur and chlorine are negative elements. 

Mention the halogens and state in what respects they 
exhibit marked similarity. 

Chlorine, bromine, iodine, fluorine. 

All are monads, all electro-negative, all form hydrogen 
acids, all possess bleaching or disinfectant action, all combine 
with metals. Except fluorine, all form oxy-acids and oxy- 
salts. 

Mention the properties of hydrogen. 

Hydrogen, symbol H, atomic weight 1, valence I, is. a color- 
less, odorless, tasteless gas. The lightest of the well-known 
elements. Practically insoluble in water, burns with a color- 
less flame, yielding more heat in its burning than any equal 
weight of any other substance. In its combustion in air it 
forms water. Mixtures of hydrogen with oxygen or air ex- 
plode when ignited. 



CHEMISTRY. 207 

Hydrogen is not poisonous, but will not support combus- 
tion nor respiration. It is electro-positive. When liquefied 
it forms a steel-blue liquid that is opaque to the passage of 
light. It is used as a standard for many scientific deter- 
minations. 

State (a) the normal specific gravity of urine, (b) the 
causes of abnormal deviations in the specific gravity of 
urine. 

(a) From 1018 to 1025. (b) Specific gravity is lowered in 
polyuria, as of diabetes insipidus in chronic interstitial neph- 
ritis. In certain nervous disorders, as hysteria, chorea, etc. 

Specific gravity is above 1025 in diabetes mellitus, in acute 
inflammation of kidney, in certain crises in the course of 
chronic nephritis accompanied by partial suppression of urine. 
In certain disorders of digestion. In febrile affections. 

Mention the principal chemical constituents of bile. 

Water, mucus and pigment, glycocholate of sodium, tau- 
rocholate of sodium, soaps, fat, lecithin, cholesterin. 

State the properties of aluminum and mention its im= 
portant salts. 

A silvery-white metal, sp. gr. 2.67, hard, ductile, malleable, 
only superficially acted upon on exposure to air, soluble in 
hydrochloric acid and in alkalies. The official compounds 
are the hydroxide, sulphate and the double sulphate of potas- 
sium and aluminum. 

Give the properties of two important compounds of zinc 
used medicinally. 

Zinc sulphate, ZnS0 4 , a white granular crystalline powder, 
used as an astringent, soluble in water and used in watery 
solution for local application. Internally, is used as an 
emetic, and in diarrhoea, etc. Zinc oxide, a yellowish-white 
powder, insoluble in water, odorless and tasteless, used in 
dyspepsia, night sweats, epilepsy, chorea, and, externally, 
in ointment form. 



208 CHEMISTRY. 

Give in detail two tests for ascertaining the presence of 
albumin in the urine. 

A long test-tube is three-quarters' filled with filtered urine, 
and the upper portion is heated to boiling. If a cloud or 
precipitate appears, add a few drops of nitric acid — phos- 
phates will dissolve and any cloudiness remaining will be 
due to albumin. 

Place a 10 per cent, solution of ferrocyanide of potassium 
in a test-tube and add to it half its volume of acetic acid; 
mix well. Then run down the side of the tube the suspected 
urine so that it floats upon the reagent without mixing. If 
albumen is present there will be impairment in transparency 
of the liquids, or even an evident precipitation if much albu- 
min be present. 

What are compound ethers? Give an example. 

Compound ethers are salts of hydrocarbon radicals, e. g., 
amyl nitrite, C 5 H 1:L N0 2 . 

What is glycerin? 

Glycerin, C 3 H 5 (OH) 3 , a triatomic alcohol obtained by de- 
composition of the fats, is a bland, heavy liquid of a charac- 
teristic sweetish taste, with a marked attraction for water 
and great solvent powers, particularly for oils, and for many 
drug substances. 

State the preparation, appearance, formula and uses of 
acetic acid. 

Acetic acid, HC 2 H 3 2 , may be obtained by destructive dis- 
tillation of wood, being separated and purified from the 
impure product, pyroligneous acid. 

It is a colorless liquid of strong, characteristic pungent 
odor and a sour or corrosive taste and action. In concen- 
trated form it crystallizes at about 60 degrees F. It is used 
for softening and removing callous tissues, as a disinfectant, 
and in preparations of its salts. 



CHEMISTRY. 209 

What chemical changes take place in the body after 
death? 

The fats undergo gradual decomposition; oxidation of 
various tissues takes place, sulphuretted hydrogen is pro- 
duced. Phosphorus leaves its chemical combinations in bone 
and other tissue to combine with hydrogen, forming PH 3 . 
Nitrogen unites with hydrogen to form NH 3 . In general 
the complex body substances, proteids, etc., split up into 
simpler compounds. 

Define base, basic radical, isomerism. 

A base is the oxide or hydroxide of a metal or basic radical. 
It is a substance which in solution will neutralize an acid 
to form salt and water. 

A basic radical is an atom, or an unsaturated group of 
atoms, having an electro-positive condition and an action 
similar to that of a base. 

Isomerism is that property, due to the atomic arrangement, 
by virtue of which chemical compounds may be composed 
of the same elements in the same percentage proportion by 
weight yet be different and distinct substances having dif- 
ferent properties. 

State the normal reaction of urine. How is the reaction 
noted? To what is it due? 

Reaction acid. By use of litmus paper, which should turn 
red when moistened with urine. Acidity due chiefly to pres- 
ence of acid phosphate of sodium. 

Define qualitative analysis, quantitative analysis. lllus= 
trate each. 

Qualitative analysis seeks to know what substances are 
present in a compound or mixture. Quantitative analysis 
seeks to know how much of a substance is present. We test 
qualitatively to see if there is any albumin in a sample of 
urine ; we test quantitatively to find out how much albumin 
is present. 
14 



210 CHEMISTRY. 

Describe the chemical process for the preparation of 
alcohol. What percentage of alcohol is found in (a) beer, 
(b) wine, (c) whiskey, (d) brandy? 

Starch is converted into dextrose, and this is then changed 
by the action of yeast into alcohol and carbon dioxide. 
2C 6 H 10 O, + H 2 = C 6 H 12 6 + C 6 H 10 O 5 

Starch Dextrose Dextrin 

C 6 H 12 6 + yeast = 2C 2 H 5 OH + 2C0 2 . 
(a) About 5 per cent, (b) 6-25 per cent., (c) 30-60 per 
cent., (d) 30-50 per cent. 

Describe two tests for glucose. 

Glucose in solution, if boiled with an alkaline cupric hy- 
drate solution, reduces the copper salt to the red sub-oxide 
of copper, forming a precipitate. 

Glucose in solution placed in the polarizing saccharimeter 
bends the rays of light towards the right. 

What are peptones and how are they produced? 

Peptones are dialyzable, feebly acid, proteid products 
formed by the action of the digestive ferments upon albu- 
minous bodies. They are very soluble in water, and are 
insoluble in alcohol and ether. 

How do globulins differ from albumins? 

Globulins are insoluble in water, albumins are soluble. 
Globulins are precipitated by saturated solutions of NaCl, 
albumins are not. 

Complete the equation: NaC 2 H 3 2 + NaOH =. 

NaC 2 H :! 2 + NaOH — CH 4 + Na 2 C0 8 . 

Explain the nomenclature of binary compounds. Which 
element is to be placed first, and how is the termination 
of the second to be altered? 

Binary compounds are those composed of two elements. 
The electro-positive or metallic element is named first, the 
name of the second element terminating in "ide. " Exam- 
ples : Ag 2 S, silver sulphide ; Nad, sodium chloride. 



CHEMISTRY. 211 

Binary acids, HOI, HBr, etc., have the prefix, " hydro,' ' 

and the suffix, "ic. " 

Define anhydride, latent heat, gravitation. 

An anhydride is a substance minus water; the name is 
applied most frequently to acidulous oxides that are capable 
of combining chemically with water to form acids, as S0 3 , 
sulphuric anhydride; N 2 5 , nitric anhydride. 

Latent heat is heat not manifesting itself as temperature; 
it is the equivalent of the energy used up in overcoming mole- 
cular attraction. 

Gravitation is the force of attraction between masses of 
matter. 

Describe methods for determining atomic weights. 

1. Determine the specific gravity of the element when in 
the gaseous state compared with hydrogen. 

2. The product of the atomic weight multiplied by the 
specific heat being 6.4, divide 6.4 by the ascertained specific 
heat of the element. 

3. Note the weight of an element required to take the place 
of a given weight of hydrogen in forming a replacement or 
substitution compound. Thus acetic acid is HC 2 H 3 2 , and 
practical demonstration shows that one grain of hydrogen in 
acetic acid may be replaced by 108 grains of silver to form 
silver acetate, AgC 2 H 3 2 ; hence one equivalent of silver 
weighs 108 times that of hydrogen, or one atom of silver 
weighs 108 compared to the weight of one atom of hydrogen. 

Explain the difference between metals and non=meta!s. 

Metals are electro-positive and combine with oxygen to 
form basic oxides. Non-metals are electro-negative and com- 
bine with oxygen to form acid oxides. 

Explain the process of manufacturing sulphuric acid on 
a large scale. 

Sulphur or a sulphide is burned in a plentiful supply of 
air, and the resulting sulphur dioxide gas, S0 2 , is carried 



212 CHEMISTRY. 

into a series of leaden-lined chambers' along with vapor of 
nitric acid and steam. The sulphur dioxide becomes oxidized 
to sulphur trioxide (S0 3 ) through the action of the nitric 
acid vapor and combines chemically with the water (steam) 
to form sulphuric acid, H 2 S0 4 . 

State the symbol, valence and atomic weight of phos= 
phorus. 

Symbol, P; valency, III. and V. Atomic weight, 31.0 

(30.77). 

What is glycogen? From what is it derived? 

Glycogen (C 6 H 10 O 5 ) n , a carbohydrate of the amylose series, 
resembles starch, forms opalescent solution in cold water; 
derived chiefly from the carbohydrates of the food, formed 
in liver and other body cells. 

Give and explain (a) an empiric formula, (b) a rational 
formula. 

(a) The simplest possible expression by formula of the com- 
position of a compound, giving the kind of elements present 
and the proportionate number of atoms, thus CH 2 is an 
empiric formula for acetic acid. 

(b) A rational formula shows the manner in which the 
different atoms or radicals combine in order to make one 
molecule of the body, thus CH 3 CO.OH. in a rational formula 
for acetic acid. 

What is the chemical antidote for poisoning from lead 
acetate? Explain the chemical action of this antidote. 

A soluble sulphate, as magnesium sulphate (Epsom salts), 
which 'in contact with acetate of lead forms an insoluble sul- 
phate of lead. 

Pb ( C 2 H 3 2 ) 2 + MgS0 4 = PbS0 4 + Mg( C 2 H 3 2 ) 2 . 



CHEMISTRY. 213 

Complete the following equations and give the names 
of the resulting compounds: 

HgS0 4 + Hg + 2N«Ca== 

FeS0 4 + 2NaHC0 3 = 

HgS0 4 + Hg + 2NaCl = Hg 2 Cl 2 (or 2HgCl) + Na 2 S0 4 

Calomel Sodium sulphate 

FeS0 4 + 2NaHC0 3 = FeC0 3 + H 2 + Na 2 S0 4 + C0 2 

Ferrous water Sodium carbon 

carbonate sulphate dioxide 

Define chemical action, physical action. Give examples 
of each. 

Chemical action takes place in the interior of the mole- 
cule. It is accompanied by the development of heat. AVhen 
chemical action occurs the identity of the bodies entering 
into chemical action is lost, and new substances are produced. 
Chemical action takes place between definite weights of the 
substances. 

Physical action takes place outside of the molecule. It is 
not necessarily accompanied by the evolution of heat. The 
substances do not lose their identity. Any quantities of the 
substances may undergo physical action. Examples: Chem- 
ical action, add HC1 to marble dust, forming a gas, carbon 
dioxide, water and chloride of calcium. Physical action, add- 
ing water to sugar we do not lose the characteristic properties 
of the water or of the sugar. 

State the chemical changes produced within a galvanic 
cell while in action. 

Cell composed of zinc and copper with dilute sulphuric 
acid. The acid dissolves zinc, forming a solution of zinc sul- 
phate. The hydrogen of the acid is given off in bubbles, 
from the copper. Thus the strength of acid is constantly 
lessened through its decomposition and the formation of 
sulphate of zinc, until finally all acidity will have disap- 
peared from the battery fluid. 



214 CHEMISTRY. 

Define distillation, sublimation, destructive distillation. 
Give examples of each process. 

Distillation consists in the passing of a liquid into a vapor- 
ous condition when heated to its boiling point, and the sub- 
sequent condensation of this vapor again to the liquid form 
on cooling the vapor. Example : Distillation of water. 

Sublimation is the passage of a solid into a vapor on being 
heated, and the condensation of that vapor again to the solid 
form on cooling without the substance having undergone 
decomposition. Example : Subliming iodine, thus obtain- 
ing it pure. Destructive distillation is a form of dis- 
tillation in which the original substance in the retort is de- 
stroyed, and from the vapors arising new substances are col- 
lected. Example: By the destructive distillation of wood we 
obtain creosote, pyroligneous acid, etc. 

What are the constituents of common illuminating gas? 
How is it prepared? Why is it poisonous? 

Marsh gas, CH 4 , olefiant gas, C 2 H 4 , acetylene gas, C 2 H 2 , 
carbon monoxide, carbon dioxide, hydrogen, and traces of 
nitrogen, and sulphur compounds. It is prepared by the 
destructive distillation of bituminous coal. Its poisonous 
effects are largely due to carbon monoxide present. 

Illuminating gas is also made by the water gas process, 
passing air and steam over highly heated carbon, and subse- 
quently enriching by mixing with naphtha vapors. 

Describe the preparation and appearance of flowers of 
sulphur, roll sulphur, precipitated sulphur. 

Flowers of sulphur, prepared by subliming sulphur and 
cooling the vapor. It is yellow in color, and examined by the 
microscope shows rounded globular masses. 

Roll sulphur, of yellow color, in sticks about two feet in 
length and two inches in diameter. Obtained by pouring 
melted sulphur into wooden moulds. 

Precipitated sulphur, a white or greenish-white powder, 
is prepared by boiling together sulphur and lime and then 



CHEMISTRY. 215 

decomposing the compound produced by the addition of 
hydrochloric acid. 

Mention the substances used for disinfection after the 
prevalence of contagious disease and explain their action. 

Sulphur burned, forming S0 2 , which acts as a disinfectant 
through its dehydrating effect upon germ life. 

Chlorinated lime dn presence of acid and by action of the 
atmospheric carbon dioxide liberates chlorine gas, and this 
latter, combining chemically with hydrogen of moisture, sets 
oxygen free ; the oxygen then -acts destructively upon disease 
germs. 

Formaldehyde, in solution or as gas, acts as a direct germi- 
cide, as do also phenol, mercuric chloride, etc. 

What percentage of C0 2 exists normally in the atmos= 
phere? What percentage C0 2 is dangerous to life? 

Atmospheric air contains .04 per cent, by volume of C0 2 . 
A greater percentage of C0 2 than 3.0 per cent, by volume 
would be dangerous to life if the C0 2 were accompanied by 
impurities from animal respiration. Ten per cent, of C0 2 
in air will prove poisonous, although unaccompanied by re- 
spiratory impurities. 

State the properties of nitric acid. 

Nitric acid, HN0 3 , specific gravity of strong acid, 1.4, 
colorless liquid, fuming in air, highly corrosive, stains upon 
tissues or fabrics, not discharged by the use of ammonium 
hydroxide. It turns litmus red, will dissolve most of the 
metals, parts readily with its oxygen, forming nitrous acid. 

Define and describe sugars. How do glucoses differ 
from saccharoses? What kind of sugar is found in dia= 
betic urine? 

Sugars are organic compounds called carbohydrates; all 
consist of C, H, and 0, with six, or a multiple of six, atoms 
of carbon and twice as many H atoms as O atoms. They 
occur in vegetable and animal structures. Glucoses are repre- 



216 CHEMISTRY. 

sented 'by the formula C 6 H 12 6 ; they reduce cupric hydrate 
to the red cuprous oxide. They crystallize with difficulty; 
they are less sweet than cane-sugar. 

Saccharoses, formula C 12 H 22 11? include the true sugars, 
cane-sugar, lactose, maltose. They may be regarded as anhy- 
drides of the glucoses. They readily crystallize, and possess 
maximum saccharin effect. 

Glucose is found in diabetic urine. 

Give the chemical name and properties of (a) calomel, 
(b) corrosive sublimate. Mention two easily applied tests 
that will distinguish one from the other. 

(a) Calomel, merourous chloride Hg 2 Cl 2 or HgCl. Is a 
laxative, may by continued use cause constitutional poisoning ; 
occurs as an impalpable, insoluble powder. "When added to 
lime water a black mixture results. 

(b) Corrosive sublimate, mercuric chloride, HgCl 2 is an 
alterative, anti-syphilitic, antiseptic and highly poisonous 
substance. It occurs in heavy white crystals, soluble in 13 
parts of water, and in 3 parts of alcohol. When added to 
lime-water a yellow mixture results. 

Give the chemical name of iodoform. How is iodoform 
made? 

Iodoform is tri-iodomethane, CHI 3 . It is made by the 
action of iodine and potassium hydroxide on ethyl alcohol. 

State the atomic theory. 

All matter is composed of minute particles called molecules, 
and each molecule is made up of indivisible parts called 
atoms; these latter in their union to form molecules unite 
in fixed quantities by weight and in obedience to fixed laws. 

Give the properties and uses of bromine. 

Bromine, Br, atomic weight 80.0 (79.36), valence I, is a 
heavy red-brown volatile liquid, specific gravity 2.99. It 
vaporizes at all temperatures, giving rise to reddish-brown 
fumes. It is slightly soluble in water, soluble in alcohol and 



CHEMISTBY. 217 

in ether, is caustic, and its vapor is irrespirable. It combines 
with many metals to form binary salts, called bromides, e. g. 
NaBr, KBr, AgBr. Used as a disinfectant, for cleaning foul 
wounds, and, in its salts, internally as medicine. 

State the valence of the following radicals: (CN), (HO), 
(N0 2 ), (CO), (HC). 

CN, monad; HO, monad; N0 2 , monad; CO, dyad; HC, 
triad. 

Give the names and formulas of three sodium salts. 

Sodium bromide NaBr. Sodium chloride Nad. Sodium 
iodide Nal. 

How is ferric chloride made? Give the chemical equa= 
tions. 

Dissolve iron in aqua regia, or ferric oxide in hydrochloric 
acid. 

Fe 2 + 6HC1 -fi 2HN0 3 = Fe 2 Cl 6 + N 2 2 + 4H 2 0. 
Fe 2 3 + 6HC1 = Fe 2 Cl 6 + 3H 2 0. 

Give in detail a test for arsenic in a mixture of food 
taken from the stomach. 

To the stomach contents add an equal weight of a mixture 
of HC1 (1 part) and water (3 parts). Digest on a water- 
bath and add small quantities of potassium chlorate until the 
organic matter is destroyed. Then filter, drive off the chlor- 
ine by passing C0 2 gas, and reduce the arsenic compound to 
the arsenous by passing S0 2 gas. 

Heat to drive off any excess of sulphurous acid, then 
through the resulting liquid pass hydrogen sulphide gas for 
several hours. Collect this precipitate, and to it add am- 
monium hydrate. Test the dissolved portion or nitrate for 
arsenic by Marsh's test. 

Define allotropism. 

Allotropism refers to elements occurring in more than one 
form, as, for instance, carbon in charcoal, graphite and dia- 
mond. 



218 CHEMISTRY. 

Give the average amount and the composition of normal 
urine voided by an adult in 24 hours. 

Amount 50 ounces 

Solids 1000 grains 

Urea 500 ' ' chlorides ( KNa) 170 grains 

Uric acid 10 " sulphates (KCa; 40 

Hippuric acid ... 15 l ' phosphates (KNa) 45 " 

Creatinine 15 " " (MgCa) 30 " 

Pigment, mucus, xanthine, other extractives. 

Mention five alkaloids. Give the derivation of each. 

Strychnine from nux vomica; morphine from opium; qui- 
nine from cinchona hark; cocaine from erythroxylon coca; 
atropine from belladonna. 

Complete the following equations: 

CH3I + HKS = 

€S 2 + 2H 2 + 6Cu = 

CH3I + HKS == CH 3 HS + KI 

CS 2 + 2H 2 + 6Cu =± 2H 2 S + C0 4 + 6Cu. 

State the properties of potassium. Mention ten potas= 
sium compounds of importance in medicine. Give for= 
mulae. 

Potassium, K, at. wt, 39.0 (38.86), valence I, is a soft 
white metal, slight bluish tint, decomposes water at all tem- 
peratures. It is one of the strongest electro- positive elements, 
is of monad valency, is lighter than water, fuses below a red 
heat. 

Compounds of importance in medicine are : Potassium 
iodide, KI ; nitrate, KN0 3 ; carbonate, K 2 C0 3 ; bromide, KBr ; 
chlorate, KC10 3 ; chloride, KC1; sulphate, K 2 S0 4 ; bi-carbon- 
ate, KHC0 3 ; cyanide, KCN; and antimonial tartrate, KSbO- 
C 4 H 4 6 . 

Give a method of determining the specific gravity of a 
solid substance insoluble in water. 

Weigh substance in air, then immerse in water and weigh 
again ; divide weight in air by loss in weight in water. Ex- 



CHEMISTRY. 219 

ample: Gold weighs 10 grains in air, in water weighs 9y 2 
grains, loss equals half a grain, then 10, weight in air, 
divided by one-half, or the loss of weight when in water, 
equals 20, the specific gravity (approximate) of gold. 

Give the chemical name, properties and uses of tartar 
emetic. 

Tartar emetic is potassium antimonyl tartrate. Formula: 
KSbOC 4 H 4 6 . 

It occurs in crystals or as a white soluble powder, chars 
when heated. Used as an emetic and as a nauseating and 
sedative expectorant, is very poisonous. 

In what part of the body is sulphur found? 

Sulphur exists in practically all tissues and fluids of the 
body in the form of sulphates or in combination in the sub- 
stances of albuminoid nature. 

What kind of albumin in morbus Brightii? What prop= 
erty renders it readily detectable? 

Serum albumen. 

It is readily detected through its coagulability by heat or 
acid. 

How is chlorinated lime made? What is the principal 
use of chlorinated lime? 

By passing chlorine gas over slaked lime. 

Ca(OH) 2 + Cl 2 = CaClOCl + H 2 0. 

Its chief uses are as a bleaching lagent and a disinfectant. 
Chlorinated lime liberates chlorine when in contact with an 
acid or with the atmospheric carbon dioxide. 

What is the difference between an alcohol and a phenol? 
Illustrate. 

Phenols differ from alcohols in : 
1st. Not forming aldehydes and acids on oxidation. 
2d. In not dividing into water and hydrocarbons under 
the influence of dehydrating agents. 



220 CHEMISTRY. 

3d. In not reacting with, acids to form ethers. 
Phenols form more stable compounds than do alcohols with 
the metallic elements. 

What are carbohydrates? Into what three groups are 
these compounds usually divided? 

Carbohydrates are organic compounds, composed of C, H, 
0, in which the H and exist in the relative proportions in 
which they are present in water and the carbon atoms in 
groups of six. 

Polysaccharids or amyloses, monosaccharide or glucoses, 
disaecharids or sucroses. 

Give the formula, uses and properties of hydrogen 
dioxide. 

H 2 2 . Used as a disinfectant, bleaching and oxidizing 
agent. 

It is usually sold in a watery solution containing from 10 
to 12 volumes of true hydrogen dioxide or about 3 per cent, 
by weight. True hydrogen dioxide is a thick, syrup-like 
liquid obtained through the exaporation of its watery solu- 
tions over strong sulphuric acid in a vacuum. It readily 
parts with an atom of oxygen, particularly if brought in 
contact with organic matter, and it is this nascent oxygen 
that effects the bleaching, disinfectant action, etc. 

Give the formula and properties of each of two oxides 
of carbon, explaining the effect of each on animal life. 

Carbon monoxide, 00. A gas almost insoluble in water, 
no odor, burns with blue flame to form carbon dioxide, is 
lighter than air. It acts as a direct poisonous agent to ani- 
mals, uniting with the hemoglobin of the blood, and thus 
destroying the oxygen- carrying power of the red corpuscles. 

Carbon-dioxide, C0 2 , is a colorless gas, heavier than air, 
no odor, soluble in water, a normal constituent of air. It is 
not a direct poison when inhaled, unless in quantities 
constituting over 10 per cent, of the inhaled air. It is, how- 



CHEMISTRY. 221 

ever, not capable of supporting life. It does not burn, nor 
does it support combustion. 

Describe the preparation of nitrous oxide, writing the 
reaction. State the properties and use of nitrous oxide. 

Nitrous oxide results when ammonium nitrate is heated in 
a retort at temperatures between 460° to 490° F. 
NH 4 N0 8 + heat = N 2 + 2H 2 0. 

It is a colorless gas, slightly sweetish taste, has no odor. 
It is soluble in water, heavier than air. It readily supports 
combustion, owing to its decomposition by the heat of the 
burning body. It does not burn. It is used for the produc- 
tion of general anesthesia of a short duration. 

Describe phosphorus as to (a) derivation, (b) proper= 
ties, (c) commercial uses, (d) medicinal uses, (e) medic= 
inal preparations. 

(a) From the mineral apatite or from bones, the latter 
containing tri-calcium phosphate. 

(b) In its usual form is a yellow wax-like solid, occurring 
also in red, black and white alio tropic forms. 

Yellow phosphorus is spontaneously inflammable in air, 
especially if it be finally divided, has an odor of garlic, is 
highly poisonous, is insoluble in water, but dissolves in oils, 
in carbon disulphide, slightly soluble in hot alcohol, etc. 
It glows in the dark, it melts and will take fire below the 
boiling-point of water. 

(c) Making matches, insecticides. Is used in certain metal 
alloys to give closer grain and prevent oxidation in the alloy, 
as in phosphor bronze. 

(d) Used medicinally in doses of l-100th of a grain in 
nerve disorders. 

(e) Medicinal preparations — phosphorus, phosphoric acid 
dilute, the phosphates, hypophosphites and phosphides. 

Give the names and formulas of the various gaseous 
compounds capable of producing general anesthesia. 

Nitrous oxide, N 2 ; chloroform, CHC1 3 ; ether, (C 2 H 5 ) 2 0. 



222 CHEMISTRY. 

A few other substances are used for the production of 
anesthesia, but they have not as general a use nor are they 
generally as satisfactory. 

Describe a method of detecting the presence of lead 
salts in water. 

Concentrate the water to small bulk, add a few drops of 
ammonium sulphide — a black or brownish-black precipitate 
or coloration insoluble in dilute hydrochloric acid indicates 
the presence of lead. 

How may the presence and amount of urea be deter= 
mined? 

Make a fresh solution of hypobromite of sodium by dis- 
solving 100 grams of caustic soda in 250 cubic centimeters 
of water, and when cold adding 25 grams of bromine. 

Place this solution in the closed arm of a Doremus' ureo- 
meter. Now add one cubic centimeter of urine, so that it 
may mix with the hypobromite solution in the long arm of 
the apparatus. The urea is decomposed, its components are 
absorbed with the exception of nitrogen gas, which, passing to 
the upper portion of the tube, depresses the column of liquid 
downward. The space occupied by the nitrogen gas indi- 
cates the quantity of urea in the sample. 

Mention a chemical antidote for sulphuric acid and ex= 
plain the action of this antidote. 

Magnesium oxide. It chemically combines with sulphuric 
acid to form sulphate of magnesium. This action is accom- 
panied by the evolution of but little heat and no gas, and all 
corrosive properties of the acid entirely disappear in the 
neutralization which it undergoes. 

What is fermentation and how is it produced? What 
are enzymes? 

Fermentation is the decomposition of a non-nitrogenous 
body by a ferment. For its production we require a ferment, 
moisture, presence of air (generally), and a temperature not 
exceeding 100° to 110° F. 



CHEMISTRY. 223 

Enzymes are soluble or unorganized ferments acting like 
yeast and other organized ferments. They are of both vege- 
table and animal origin. Those of animal origin are found 
in digestive fluids, as pepsin in gastric juice, ptyalin in saliva. 

Differentiate chemically sucrose, glucose, lactose and 
maltose. 

Sucrose, C 12 H 22 11 , does not reduce alkaline cupric solu- 
tions and does not ferment with yeast. 

Glucose. C 6 H 12 6 , reduces alkaline cupric solutions and 
ferments with yeast. 

Lactose, C 12 H 22 11 .H 2 0, reduces alkaline cupric solutions 
and does not ferment with yeast. 

Maltose, C 12 H 22 1:L .H 2 0, does not reduce Barford's reagent 
(acetic acid solution of copper acetate), otherwise is similar 
to glucose. 

Complete the following equations: 

Fe01 3 + 3NH 4 OH = 

MgCL + NH 4 C1 + Na 3 P0 4 =. 

FeCL + 3NH 4 OH = Fe(OH) 3 + 3NH 4 C1. 

MgCl 2 + NH 4 C1 + Na 3 P0 4 = XH 4 MgP0 4 + 3NaCl. 

Describe oxygen as to occurrence, preparation, physical 
properties, chemical properties, office in the body. 

Oxygen, 0, atomic weight 16 (15.88) valence II, occurs in 
free state, forming about one-fifth of the atmosphere. It is 
found chemically combined with i/g of its weight of hydrogen 
in water and is present in many mineral and organic com- 
pounds. It is the most widely distributed of elementary 
substances. 

Prepared by heating a mixture of potassium chlorate and 
manganese dioxide. Physically, oxygen is a colorless, taste- 
less, odorless gas, slightly heavier than air. It is soluble to 
the extent of 3 per cent, in water. 

Chemically, oxygen supports combustion, does not burn, is 
strongly electro-negative, is of dyad valency, combines chem- 
ically with all elements excepting fluorine and argon. 



224 CHEMISTRY. 

It supports animal life; it is carried by the red 
blood corpuscles to every cell of the body, upon which it 
acts destructively to allow of regeneration of tissues. 

It is used remedially where from any cause respiration is 
impaired or prevented. 

What is chlorine? How is it prepared? How is chlor= 
ine administered medicinally through the mouth? 

A yellowish-green gas with suffocating odor, about 2y 2 
times the weight of air, soluble in water. Administered med- 
icinally in aqueous solution known in pharmacy as liquor 
chlori compositus, containing about 0.4 per cent, chlorine. 

Prepared by heating a mixture of manganese dioxide and 
hydrochloric acid, and collecting the gas evolved by displace- 
ment. 

Mn0 2 + 4HC1 = MnCl 2 + 2H 2 + Cl 2 . 

Define alloy, amalgam. Give an example of each. 

An alloy is a combination of two or more metals. Ex- 
ample : Brass, an alloy of zinc and copper. An amalgam is 
an alloy in which one of the metals is mercury. Example : 
Tin amalgam, composed of tin and mercury, used in making 
of mirrors. 

How is hydrogen sulphide formed in nature? How is 
hydrogen sulphide prepared in the laboratory? 

It results, in nature, from the decomposition of organic 
matter containing sulphur in the presence of moisture. Ex- 
ample : The rotting of an egg gives rise to hydrogen sulphide 
from the union of the sulphur in the albumen with the hy- 
drogen of water. Also found in certain volcanic gases and in 
some mineral waters. 

Hydrogen sulphide may be prepared in the laboratory by 
adding dilute sulphuric acid to ferrous sulphide, as 
FeS + H 2 S0 4 = FeS0 4 + H 2 S. 

Explain the significance of the following prefixes: 
Hydro, sub, hyper, nitro, bi. 

Hydro as a prefix is used in the naming of hydracids, e. g. 
Hydrochloric acid, HC1. 



CHEMISTRY. 225 

Sub as a prefix is the equivalent of the suffix "ous, " sig- 
nifying a lower valence (real or apparent) of the positive 
element in a binary compound than is indicated by the suffix 
"ic. " It is also used in indicating certain basic salts, e. g., 
subnitrate of bismuth, BiON0 3 . 

Hyper as a prefix is used especially in indicating a greater 
relative amount of oxygen than is contained in another com- 
pound of the same elements. 

Nitro indicates the presence in a compound of the radical 
N0 2 , as C 6 H 5 N0 2 , nitrobenzene. 

Bi indicates two atoms of the element so designated in 
chemical combination with another element, as CS 2 , bi-sul- 
phide of carbon. 

Mention the metals whose salts are often taken as 
poisons. 

Silver, lead, mercury, arsenicum, antimony, copper, tin, 
zinc, barium. 

What is common salt? State where and how common 
salt is obtained, and give the chemistry of its use for 
freezing purposes. 

Sodium chloride, NaCl. Obtained by evaporation of sea 
water, and from salt deposits. 

When salt is mixed with snow or ice it occasions a rapid 
melting — heat is rendered latent, such heat being extracted 
from neighboring bodies. 

Explain the formation of a vesical calculus having a uric 
acid nucleus. 

An aggregation of uric acid crystals, from their sharp 
angular character irritate the vesical mucous lining, so 
that they become surrounded with mucus, and then, from 
inflammation produced, we may have decomposition of 
urine, with accompanying deposition of alkaline urates, or 
phosphates, around the original mass. 
15 



226 CHEMISTRY. 

Give two tests for morphine. 

Touch the suspected alkaloid with nitric acid, and if it be 
morphine it dissolves, yielding an orange-red liquid that 
soon fades to yellow. 

To morphine add neutral ferric chloride solution — a blue 
color is produced. 

When are substances said to (a) isomeric, (b) meta= 
meric, (c) polymeric? 

Substances are isomeric when they are made up of the 
same elements in the same percentage proportion. 

Two or more bodies are metameric when composed of the 
same elements in the same percentage composition and when 
they have the same molecular weight. 

Polymeric bodies are composed of the same elements in the 
same percentage composition but with different molecular 
weights. 

Write a reaction for making barium sulphate from 
sodium sulphate. How many grams of sodium sulphate 
are required to yield 2.33 grams of barium sulphate by 
this process? (Atomic weight of barium equals 37.) 

Na 2 S0 4 + BaCl 2 = BaS0 4 + 2NaCl. 
142Na 2 S0 4 make 233 of BaS0 4 . 

If 233 grams of barium sulphate require 142 grams of 
sodium sulphate, then 233 : 142 : : 2.33 : X, or 1.42. 
Result, 1.42 grams of sodium sulphate required. 

Describe and illustrate (a) monobasic acid, (b) dibasic 
acid, (c) tribasic acid. 

(a) An acid containing one atom of hydrogen capable 
of being replaced by a metal or an electro-positive rad- 
ical, as HC 2 H 3 2 , acetic acid; AgC 2 H 3 2 , argentic acetate. 

(b) An acid which contains two replaceable hydrogen 
atoms in each molecule, as H 2 S0 4 , sulphuric acid; Na 2 S0 4 , 
sodium sulphate. 

(c) An acid which contains three replaceable hydrogen 



CHEMISTRY. 227 

atoms in each molecule, as H 3 P0 4 , phosphoric acid; Na 3 P0 4 , 
normal sodium phosphate. 

Write chemical equations showing two methods of ob= 
taining hydrogen. 

Zn + H 2 S0 4 = ZnS0 4 + H 2 . 
Zn + 2KOH = K 2 Zn0 2 + H 2 . 

What is the meaning of the words monad, tetrad and 
pentad? Give an example of each. 

Monad refers to an element or compound radical whose 
power of combination is the same as that of hydrogen. Thus 
chlorine is a monad, one atom of H uniting with one atom of 
chlorine. 

Tetrad is an element or compound radical exhibiting a 
combining power four times that possessed by hydrogen. 
Example : Carbon, as in marsh gas, CH 4 . 

A pentad has a combining power equal to five times that 
of hydrogen. Example : Phosphorus, in its compound phos- 
phorus pentachloride, P01 5 . 

Describe cyanogen and its principal compounds. 

Cyanogen, symbol, Cy or CN. 

This body is an organic compound radical composed of 
equal volumes of carbon and nitrogen vapors. It is a color- 
less, inflammable gas. soluble in water. It exists in a divided 
form in many vegetable structures, is electro-negative or acid- 
ulous, of monad valency, and resembles chlorine in chemical 
compounds which it forms. 

Important compounds : Hydrocyanic acid, HCN. A very 
volatile liquid with characteristic odor used in dilute aqueous 
solution. Very poisonous. KCN, potassium cyanide, a 
white, deliquescent, poisonous solid. Potassium ferro- 
cyanide and potassium ferri-eyanide have considerable use 
in arts and manufactures and as chemical reagents. Nickel, 
silver and gold cyanides are all used for electro-plating pur- 
poses. 



228 CHEMISTRY. 

What are the source and principal properties of vase= 
line? 

Vaseline is obtained by purifying the residue, after dis- 
tilling the more volatile substances from petroleum. 

It is a more or less fluorescent, unctuous solid, melting at 
from 104 to 125 degrees Fahr. It is almost odorless and 
tasteless. 

Give the general characteristics of the aluminum group 
of elements. 

Metals of aluminum group include aluminum, indium, gal- 
lium, and others still less common. They form compounds of 
the type M'01 3 or M 2 3 . Their oxides are weak bases; their 
sulphates, with the sulphates of alkali metals, form double 
salts called alums, which crystallize in the regular isometric 
system. 

The oxides and hydroxides are insoluble in water, as are 
also the phosphates and carbonates. 

Give a typical example of each of the following classes 
of mineral waters: (a) Saline cathartic, (b) alkaline, (c) 
sulphurous. 

(a) Epsom spring water (England) , containing magnesium 
sulphate. 

(b) Vichy, containing sodium bicarbonate. 

(c) Richfield spring, containing hydrogen sulphide. 

Describe one of the processes by which HC1 and N may 
be prepared. 

HC1 is prepared by heating sulphuric acid with common 
salt and passing the evolved gas into water. 

N is prepared by passing air over incandescent copper, the 
metal uniting with the oxygen present. 

Explain the difference between the Fahrenheit, centi= 
grade and Reaumur thermometers. 

The freezing-point of water in the Fahrenheit scale is placed 
at 32 degrees, while in the Centigrade and Reaumur scales 



CHEMISTRY. 229 

this point is made zero. The boiling-point in the Fahrenheit 
scale is 212 degrees, the Centigrade scale 100 degrees, Reau- 
mur 80 degrees. Between the freezing and boiling points of 
water in the F. scale we have 180 degrees, in C. scale 100, in 
R. 80. Hence each degree F. would correspond to V 9 of a 
degree C. and V 9 of a degree R. 

What is litmus? Explain its uses in urinalysis. 

Litmus is a vegetable substance obtained from a species of 
lichen. 

In urinalysis we use it generally in the form of litmus 
paper (paper impregnated with an aqueous solution of lit- 
mus) to determine the reaction of urine. Blue litmus is red- 
dened by acids; red litmus is turned to a blue by alkalies, 
permanently if the alkalies be fixed, transiently (removable 
by warming) if the alkali be volatile. 

Give the chemical differences between chloral and chlo= 
roform. 

Chloral is formed from aldehyde by substituting three 
chlorine atoms for three hydrogen atoms ; aldehyde, CH 3 COH ; 
chloral, CCl 3 COH. 

Known chemically as trichloraldehyde. 

Chloroform is trichlormethane. or marsh gas, in which 
three hydrogen atoms have been replaced by chlorine atoms; 
marsh gas. CH 4 ; chloroform, CHC1 3 . 

Complete the following equations: 

CaCl 2 + (NH 4 ) 2 C0 3 = 
CH 4 N 2 + 2H 2 6 = 

CaCl 2 + (NH 4 ) 2 C0 3 = CaC0 3 + 2NH 4 C1. 
OH 4 N 2 + 2H 2 6 = (NH 4 ) 2 C0 3 . 

Define malleability, endosmosis. 

Malleability is that property by virtue of which certain 
metals may be hammered or rolled out into thin sheets. 
Endosmosis refers to the passage of a liquid of a certain 
density inward through a porous partition to mix with a 
liquid of different density. 



230 CHEMISTRY. 

Give the general characteristics of rain water, well 
water, river water, and lake water. 

Rain water, a soft water, containing gases dissolved from 
the atmosphere but only a small amount of solids. Well 
water, character depends upon depth and location of well, 
upon surrounding conditions, nature of soil, etc. River water 
depends upon source and exposure ito contamination — sewage, 
manufacturing waste, geological conditions. Lake water is 
similar to river water, depending upon conditions for its 
purity or contamination. 

Give the method of preparation and the special charac= 
teristics of ozone. 

It may be prepared by passing electric discharges through 
moist air or oxygen or by the slow oxidation of moist phos- 
phorus. 

Ozone is a bluish gas with irritating effect upon respiratory 
mucous surfaces ; it is an active oxidizing agent. 

Test : Paper saturated with a mixture of starch mucilage 
and potassium iodide solution will be turned blue by contact 
with ozone. 

What is flourine and where is it obtained? State the 
preparation and the practical uses of hydrofluoric acid. 

Fluorine, F., atomic weight 19 (18.9), valence I, a nearly 
colorless gas, the first one of the halogen series of elements, 
occurs in nature in combination with metals as fluorides, 
e. g. calcium fluoride or fluorspar, CaF 2 . 

Hydrofluoric acid is made by heating calcium fluoride and 
sulphuric acid in a leaden vessel and passing the evolved gas 
into water, in which it readily dissolves. Its chief use is as 
a solvent for glass, used for etching, etc. 

What are the constituent parts of boroglycerid and what 
is its use in medicine? 

Boric acid and glycerin. U. S. P. Glyceritum boroglycer- 
ini, 31 per cent, boric acid dissolved in glycerin. It is anti- 
septic and detergent. 



CHEMISTRY. 231 

What are the properties of lead? What is litharge? 
Give the toxicology of lead. 

Lead, Pb, atomic weight 205 (205.33), valence II; a soft, 
heavy, bluish-white metal, tarnishes rapidly on exposure to 
air. Melts at 325° C. ; sp. gr. 11.37 ; oxidizes when heated 
in air to form yellow oxide of lead or litharge. Soluble in 
nitric acid, in acetic acid, in very strong hot sulphuric acid. 

Litharge is monoxide of lead, PbO. 

Lead may occasion acute or chronic poisoning. In acute 
lead poisoning we have the action of an irritant — vomiting, 
abdominal cramps, constipation. Chronic lead poisoning, as 
it occurs in painters or in those constantly exposed to the 
fumes of lead and its components, is characterized by anemia, 
obstinate constipation, abdominal colic, paralysis of extensor 
muscles, producing "wrist-drop" and many obscure nervous 
symptoms, paralyses, anesthesias, etc. Antidotes : magnesium 
sulphate and sodium sulphate. 

Give the preparation, formula and characteristics of 
bromide of ammonium. 

Ammonium bromide, NH 4 Br. Place one pound of bromine 
in a stone jar, add to it carefully four times its weight of 
water, then add half ounce at a time, very slowly, one quart 
of ammonia. 

6Br + 8NLI 3 = 6NH 4 Br + N 2 . 

It is a white crystalline salt, saline taste, permanent in air, 
soluble in water; heated with caustic soda evolves odor of 
ammonia. Passing chlorine gas through its water solution 
bromine is disengaged. 

Ammonium bromide acts upon the system as a depressant 
to the motor function of spinal cord. Its chief uses are to 
produce sleep and allay nervous irritability. 

Give a description of the preparation and mention the 
properties of the principal alcoholic beverage obtained 
from the fermentation of malted grains. 

The brewer "mashes" the ground malt with water, and 



232 CHEMISTRY. 

beats at about 180 degrees F. for several hours, when such 
starch has not been already changed by germination of the 
grain is now converted into dextrin and sugar. 

The resulting liquid, "wort," is boiled with hops and 
the mixture is allowed to stand, yeast is added, and the 
liquid fermented. Glucose is changed to alcohol, with a fur- 
ther formation in the liquid of traces of lactic, succinic, car- 
bonic and acetic acids, glycerin, etc. 

The fermentative process is finally stopped by heating the 
liquid. 

Ale, porter, stout and beer differ only in the selection and 
proportion of the malt, hops and flavoring material. They 
vary in alcoholic content from 1 to 10 per cent, with an aver- 
age of 4 to 5 per cent,, ales and stouts being generally richer 
in both extractives and alcohol than are the beers. 

What is the normal amount of uric acid excreted in 24 
hours by an adult, and what effect has diet on the quantity 
so excreted? 

From 0.3 to 0.8 grammes in 24 hours, Increased by a diet 
rich in nitrogen, as of meats, peas, beans, eggs, etc., and by 
alcoholic beverages. 

What is the fever thermometer? How is it made and 
graded? 

A small glass thermometer of a minute capillary bore, with 
a constriction in the lumen immediately above the mercurial 
chamber. The mercury, in its expansion, passes up the tube, 
but on cooling and contracting cannot, by its own weight, fall 
down past the constricted portion. 

The steps of manufacture are calibrating the tube, filling 
and curing the tube, and finally graduating the finished in- 
strument, The scale is generally from 90 degrees Fahr. to 
110 degrees Fahr., each degree being divided into five equal 
spaces. 



CHEMISTRY. 233 

What is the relative importance of the element carbon 
in organic chemistry? 

All organic compounds contain carbon. It is the essential 
element whose presence classes the body as organic. 

In testing urine by heat in a case of suspected albu= 
minuria, what substances might be precipitated and so 
make the test deceptive? 

Phosphates of calcium and magnesium. 

Describe the chemical process (a) when iron rusts, (b) 
when wood burns, (c) when silver is tarnished by coal gas. 

(a) The rusting of iron is an oxidation process, the final 
product being ferric hydroxide, Fe 2 (OH) 6 . 

(b) Wood burns to form carbon dioxide and water. 

(c) Silver, in presence of coal gas, becomes coated with 
black sulphide of silver, AgS, from the presence in the coal 
gas of sulphur compounds. 

Describe the manufacture of illuminating gas. 

Coal gas process : Bituminous coal is subjected to destruc- 
tive distillation in retorts, the gaseous product being then 
successively cooled to remove the less volatile tar, washed 
with water to remove ammonia, and passed through lime to 
remove the sulphur compounds. 

Water gas process : Air and steam, alternately, are passed 
over red-hot coke or anthracite coal. 

C 2 + 2H 2 = 2CO + 2H 2 . 
The gas produced is given illuminating value by enriching 
with naphtha. 

Mention the antidotes applicable in cases of poisoning 
from (a) caustic alkalies, (b) carbolic acid. 

(a) Vinegar, lemon juice, oils, fats, mucilaginous drinks. 

(b) Soluble sulphates, as sodium or magnesium sulphate, 
oils, fats, albumin, vinegar, and alcohol. 



234 CHEMISTRY. 

Where is oxygen found in the human body and what 
are its important uses in the animal economy? 

It is present in all animal tissues and fluids. Oxygen is 
necessary for the oxidation and removal of existing- tissues, 
with subsequent replacement by new structures. It is only 
through the ingestion of oxygen, in respiration, that animal 
life is maintained. 

When sulphur is burned in the air, what is the product 
and what are its uses? 

Sulphur dioxide or sulphurous anhydride, S0 2 . 

It bleaches organic colors, is a disinfectant, and stops or 
limits fermentation. In the arts it is used for the manufac- 
ture of sulphuric acid and other chemical bodies. 

Write the formulas for (a) sodium sulphate, (b) potas= 
sium nitrate, (c) ammonium chloride. 

(a) Na 2 S0 4 . (b) KN0 3 . (c) NH 4 C1. 

Describe the method of obtaining H and O by passing 
an electric current through H 2 0, and tell how to deter= 
mine which gas is O. 

Seal two platinum wires in the opposite sides of a glass 
flask, solder two upright strips of platinum to these entering 
horizontal wires. Connect one of the entering wires with the 
positive pole of a galvanic battery of several cells and the 
other wire with the negative pole. Place in flask water ren- 
dered faintly acid with sulphuric acid, and invert two test- 
tubes, filled with this same acidified water, over the platinum 
terminals. Pass the current and gas will accumulate in both 
tubes, the oxygen with half the rapidity of the hydrogen. 
The gas may be further identified by plunging into it a frag- 
ment of glowing wood, which will be kindled to a brilliant 
flame by the oxygen. 

What is effervescence and what is efflorescence? 

Effervescence refers to the bubbling off of a gas, e. g., the 
escape of carbon dioxide on treating a carbonate with an acid. 



CHEMISTRY. 235 

Efflorescence refers to the loss of water of crystallization 
which certain crystals undergo when exposed to air. They 
dry out, become powdery and lose their crystalline form. 

What changes take place in alcoholic fermentation? 

Glucose is converted into alcohol and carbon dioxide gas: 
C 6 H 12 6 = 2C 2 H 5 OH + 2C0 2 . 

What is understood by specific gravity, and what pre= 
cautions are advisable in the use of the urinometer? 

(a) By specific gravity of a substance we mean the ratio, 
or relation by weight, the substance bears to the weight of 
an equal volume of some substance used as a standard. 

(b) The temperature of the liquid to be examined should 
correspond with the temperature for which the instrument is 
graduated, otherwise a correction should be made. The in- 
strument should be free of any adhering bubbles. The urino- 
meter tube should be filled to the brim. 

Give the chemical name and formula of (a) water, (b) 
common salt, (c) carbonic acid, (d) nitric acid. 

(a) Hydrogen monoxide, H 2 0. (b) Sodium chloride, 
N-aCl. (c) Carbonic acid or hydrogen carbonate, H 2 C0 3 . 
(d) Nitric acid or hydrogen nitrate, HN0 3 . 

How does fire=damp explode in mines? 

AVhen marsh gas escapes from fissures in coal formations 
and mixes with air, it explodes with violence on contact with 
a naked flame or spark, the chemical results being carbon 
dioxide and water. 

If the proportion of air rises to 18 times the volume of 
marsh gas no explosion occurs. 

Demonstrate the fact that air is a mixture, and not a 
compound. 

Pass air through water that has been boiled, and 3 per 
cent, of the oxygen of the air will be retained dissolved in 
the water, while less than 1 per cent, of nitrogen will be re- 
tained by the water. 



236 CHEMISTRY. 

What is the chemical antidote in case of poisoning by 
tartar emetic? 

Tannic acid. 

What is the formula of sulphuretted hydrogen? What 
are some of its properties and uses? 

Sulphuretted hydrogen, H 2 S, is a colorless gas, slightly 
heavier than air, of a disgusting, characteristic odor. Burns 
with a blue flame when ignited, forming sulphur dioxide and 
water. 

It is used as a group reagent to precipitate metals of the 
so-called second analytical group. 

Which metal is (a) the least tenacious, (b) the most 
infusible, (c) the best for electro=magnets, (d) the best 
for electro-conductors, (e) the most rare? 

(a) Mercury; (b) osmium; (c) iron; (d) silver; (e) ra- 
dium. 

Describe the process for the preparation of nitric acid. 

Prepared by the action of sulphuric acid on sodium nitrate 
in glass or cast-iron retorts. 

NaN0 3 -f H 2 S0 4 = NaH'SO, + HN0 3 . 

Give the flame test for barium and strontium. 

Moisten a clean platinum wire with hydrochloric acid, and 
dip it into the powdered barium salt; hold the wire in the 
Bunsen flame, a green color will be obtained. 

Strontium, under like 'conditions, will give a brilliant red 
color. 

What is the per cent, of each constituent present in 
sulphuric acid, the atomic weight of sulphur being 32? 

The molecular weight of H 2 S0 4 is 98. In 98 parts, then, 
of H 2 S0 4 there are, hydrogen 2 parts, sulphur 32 parts, 
oxygen 64 parts. 

In 100 parts there will be, of hydrogen (2 -f- 98) X 100 = 
2.04 per cent. ; of sulphur (32 -f- 98) X 100 = 32.65 per cent. ; 
of oxygen (64 ~ 98) X 100 = 65.31 per cent. 



CHEMISTRY. 237 

What are principal constituents of milk? 

Water, fats, sugar (lactose), proteids including caseinogen 
and milk albumin, and mineral salts, chiefly phosphates and 
chlorides of calcium, magnesium, sodium and potassium. 

To what impurity is the occasional toxic effect of bis= 
muth salts due? 

Arsenic. 

Give the chemical reason why diabetics should abstain 
from starchy foods. 

Because of the conversion of starch into glucose through 
the action of ptyalin in saliva, and amylopsin in pancreatic 
juice. Glucose thus formed cannot be broken up into other 
substances because of loss of power of liver cells to effect the 
change, so that this glucose passes directly into the blood, 
from which it is eliminated ! by the kidneys. 

What chemical changes take place as a result of mus= 
cular activity? 

Oxidation of tissue substance with increased formation and 
elimination of urea from decomposed nitrogenous structures. 
Increased rapidity of circulation brings formative material 
fro quickly repair this loss or waste, so that tissues are rapidly 
destroyed, rapidly replaced, and the waste rapidly removed 
through exercise. 

What is the difference between fermentation and putre= 
faction? 

Fermentation is the decomposition of a complex substance 
by the action of a ferment, 

Putrefaction is the decomposition of nitrogenous bodies by 
the action of bacteria. 

Mention the antidotes applicable in a case of poisoning 
from iodine. 

Starch, mucilaginous drinks, flour, milk, white of egg. 



238 CHEMISTRY. 

Describe chloral hydrate. 

Chloral hydrate, CCl 3 COH.H 2 0. 

A colorless, transparent, crystalline solid, pungent odor, 
acrid taste, very soluble in water. It liquefies if triturated 
with camphor, phenol, menthol, or thymol. Used as a hyp- 
notic. 

Give a chemical explanation of the souring and curdling 
of milk. 

A ferment acts upon the sugar of milk changing it to 
lactic acid; this lactic acid then produces a sour taste and 
coagulates the casein. 

Name each of the following: (a) H 2 S0 2 , (b) H 2 S0 3 , (c) 
H 2 S0 4 , (d) H 2 S 2 3 . 

(a) Hyposulphurous acid; (b) sulphurous acid; (c) sul- 
phuric acid; (d) thio-sulphuric acid (from which the class 
of salts known as hyposulphites is obtained). 

What are the chemical constituents of biliary calculi? 

Cholesterin, pigments, biliary acids, mucus, epithelium, car- 
bonate of calcium, fats. 

Describe your mode of procedure in making a chemical 
examination of suspected urine. 

Ascertain quantity passed in 24 hours and obtain an aver- 
age specimen. Note color, appearance and odor. Test the 
reaction with litmus paper and take the specific gravity. 
Filter the urine and test for albumin by heat or nitric acid 
tests, and for sugar by Fehling's or Haines' tests. Deter- 
mine the amount of urea by the hypobromite method. Test 
for chlorides with acidified silver nitrate, for sulphates with 
acidified barium chloride, and for phosphates with magnesia 
mixture. Test for indioan by use of concentrated hydro- 
chloric acid. 

Describe the theory of the construction of the metric 
system. 

The metre, unit of linear measure, is the one ten-millionth 



CHEMISTRY. 239 

of a quadrant of a great circle of the earth. The metre is 
39.37 inches in length. It is divided into ten equal parts 
called decimetres. 

Each decimetre is divided into ten equal parts called cen- 
timetres. 

Each centimetre divided into ten parts called millimetres. 

Ten metres measure one dekametre; ten dekametres equal 
one hectometre; ten hectometres equal one kilometre. 

A cubic centimetre of distilled water, at four degrees Cent., 
weighs one gramme, the unit of weight equaling, in the Eng- 
lish system, 15.432 troy grains. 

The gramme is divided and subdivided, like the metre, into 
deci-. centi-, milligrammes, and we also have the multiples, 
deka-, heeto-, kilogrammes, referring respectively to 10, 100 
and 1000 grammes. 

A cubical vessel with a length of side of one decimetre 
holds one litre of liquid, the measure of capacity. A litre 
contains 1000 cubic centimetres, and is nearly equal to the 
English quart. 

Wherein do wine, beer and whiskey differ? 

AVine is a fermented fruit juice containing from 6 to 25 per 
cent, of alcohol, has present as well compound aromatic ethers 
and other volatile principles. 

Beer is a malt liquor containing 4 to 5 per cent, alcohol, 
with bitters (hops), and extractives (malt). 

AVhiskey is a distilled liquor containing 30 to 60 per cent. 
alcohol, containing also aromatic substances. 

The skeleton of a man weighs 24 pounds and contains 
58 per cent, of calcium phosphate, Ca 3 (P0 4 ) 2 . Find the 
weight of phosphorus present. (Atomic weight of Ca, 40; 
of P, 31.) 

There are present in the skeleton 13.92 lbs. of calcium 
phosphate (58 per cent, of 24 = 13.92). 

Calcium phosphate, molecular weight 310, contains 62 of 
phosphorus. 

310 : 62 : : 13.92 : X = 2.784 lbs. of phosphorus. Answer. 



240 CHEMISTRY. 

Distinguish between physics and chemistry. 

Physics treats of the phenomena presented to us by bodies 
or masses of matter as such. Chemistry treats of the compo- 
sition of matter and of the changes which this composition 
may undergo. 

What is the unit of comparison in determining the spe= 
cific gravity of liquids? Of gases? 

For liquids, pure water at 4° C. and standard barometric 
pressure ,(760 millimetres). 

For specific gravity of gases we use pure dry atmospheric 
air at 0° C. and 760 millimetres pressure or pure dry hydro- 
gen at the same (standard) temperature and pressure. 

Define qualitative analysis and give a principal method. 

Qualitative analysis is that form of analysis which seeks to 
determine the hind of substances present in a compound or 
mixture. 

A common method is to dissolve the substance to be ana- 
lyzed and then by means of appropriate reagents to precipi- 
tate and filter off successively its constituent parts. 

Define (a) element, (b) compound, (c) mixture, (d) 
solution, (e) precipitate. 

(a) A substance all of whose atoms are of the same kind, 
(to) A substance containing at least two different kinds of 
atoms chemically combined. (ic) A mechanical mixture of 
two or more substances, which substances may be in any pro- 
portion and may retain their characteristic properties, (d) 
A solution is a liquid in which a solid, or a gaseous substance, 
has been dissolved. (e) A substance made insoluble in the 
liquid in which it was dissolved, by chemical action. 

Which of the elements are gases at ordinary tempera= 
ture and pressure? 

Hydrogen, oxygen, nitrogen, chlorine, fluorine, argon, and 
a number of elements recently discovered. 



CHEMISTRY. 241 

Where do Na, Hg, Cu occur in nature? Which occur 

free? 

Copper occurs free in nature, and also in a number of 
mineral combinations, the sulphide, carbonate, oxide, etc. 
Mercury occurs free, although but in limited quantity. 
Sodium occurs principally in union with chlorine as NaCl 
found in sea water, mineral springs, in natural water, in 
nearly all plant and animal structures. Mercury is found 
in nature chiefly in the ore cinnabar, HgS. 

Describe hydrochloric acid as to its occurrence. 

We find hydrochloric acid present in certain animal fluids, 
as in gastric juice, and it is found in a few natural mineral 
waters. 

How does each of the following affect litmus paper: 
(a) H 2 0, (b} H 2 S0 4 , (c) (NH) 4 OH? 

(a) No effect, (b) Turns it red. (c) Turns it blue. 

The quantity of urine being insufficient for the urino= 
meter, how would you proceed? 

Use a small piknometer, or specific gravity flask ; weigh the 
flask filled with urine and then when filled with pure water. 
Divide the weight of the urine by the weight of water. 

Or, dilute the urine with a measured quantity of water and 
determine the specific gravity of the dilute mixture by means 
of the urinometer. From this calculate the true specific grav- 
ity, e. g., if 2 parts of water were added to 1 part of urine, 
and the specific gravity of this mixture were 1005, the true 
specific gravity of the urine would be 1015. 

Distinguish between starch and sugar. By what histo= 
logic element is starch converted into sugar? 

Starch is colloidal, its formula C 6 H 10 O 5 . It is soluble in 
cold water, forms a mucilage in hot water. Turns iodine 
blue, rotates light to the right, has no sweet taste. 

Sugar is crystalline, its formula C-^ELoOn. It is soluble 
in cold or hot water, it rotates light to the left, it yields no 
16 



242 CHEMISTRY. 

color with iodine, it possesses a characteristic sweet taste. 
Starch is converted into sugar (maltose, C 12 H 22 O n , and glu- 
cose, C 6 H 12 6 ) by ptyalin and by amylopsin. 

Complete the equation CaCl 2 -f Na 2 C0 3 = . 
CaCl 2 + N.a 2 00 3 = CaC0 3 + 2NaCl. 

Mention the antidotes applicable in cases of poisoning 
from (a) oxalic acid, (b) copper sulphate. 

(a) Magnesia and lime water. 

(b) Albumin and ferrocyanide of potassium. 

What is chemical decomposition? 

Chemical decomposition refers to the breaking up of a com- 
pound into simpler substances. 

Give an example of a synthetic operation. 

The formation of cupric oxide by heating the metal copper 
in air or oxygen; or, mixing two parts hydrogen and one 
part oxygen by volume and heating, an explosion occurs and 
vapor of water is formed. 

What are the products of the combustion of ordinary 
coal? 

Principally carbon dioxide. There may also be produced 
carbon monoxide, sulphur dioxide, water, and other sub- 
stances resulting from the burning of impurities in the coal. 

In composition with what elements are the following 
most commonly found in nature: (a) Iron, (b) gold, (c) 
silver, (d) copper, (e) chlorine? 

(a) Oxygen or sulphur, (b) Sulphur, (c) Sulphur, tel- 
lurium and chlorine, (d) Sulphur, oxygen, (e) Sodium. 

Describe the production of oxygen by decomposition of 
potassium chlorate. Give the formula and equation. 

Heat potassium chlorate with or without an addition of 
manganese dioxide and oxygen will be liberated. 
2KC10 3 + heat = 2KC1 + 30 2 . 



CHEMISTRY. 243 

Explain an experiment to prove that chemical action 
may be induced by electricity. 

Mix equal volumes of hydrogen and chlorine gases in a 
tube through, the sides of which pass two platinum wires 
connected with a battery or induction coil. An electric 
charge being sent through the wires the hydrogen and chlorine 
combine with explosive violence to form hydrochloric acid. 

Name and describe some of the more important potas= 
sium salts. 

Potassium carbonate, K 2 C0 3 . May be prepared from wood- 
ash and from the chloride, a white granular, deliquescent 
powder, very soluble in water, insoluble in alcohol. 

Potassium chlorate, KC10 3 . Colorless, pearly, plate-like 
crystals, soluble in 16 parts water, permanent in air, a strong 
oxidizing agent. 

Potassium nitrate, KN0 3 . Made by the reaction between 
sodium nitrate and potassium chloride. Prismatic crystals 
of cooling, saline taste, slightly hygroscopic in moist air. 
Soluble in 3.6 parts water, very sparingly soluble in alcohol. 
A strong oxidizing agent. 

Potassium bromide, KBr. "White cubical crystals of saline 
taste, soluble in 1.7 parts water and in 12.5 parts alcohol. 

Potassium iodide, KI. Similar to the bromide, soluble in 
0.7 part water and in about 12 parts alcohol. 

Potassium acetate, KC 2 H 3 2 . A white powder or in crys- 
taline masses of a satin-like lustre, odorless and having a 
warming, saline taste. Very deliquescent, soluble in 0.4 part 
water, and in 2 parts alcohol. 

What is the formula for (a) chloroform, (b) sulphuric 
ether, (c) alcohol? 

(a) CHC1 3 . (b) (C 2 H 5 ) 2 0. (c) C 2 H 5 OH. 

How would you conduct an autopsy for the purpose of 
testing for arsenic in the stomach and tissues? 

The analytical chemist should be present, if possible, at the 



244 CHEMISTRY. 

autopsy. Tie bath pyloric and cardiac ends of the stomach 
and place with its contents, in a Chemically clean glass jar. 
Close the jar with a close-fitting glass stopper; seal it, and im- 
print a design upon the seal in such manner that the design 
will he broken should the jar be opened. Proceed, in the 
same manner, to save a portion at least of the liver, the small 
intestine, portion of large intestine, the spleen, one kidney, 
the brain. Each of these organs to be kept separately. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

2NaCl + H 2 S0 4 = 
OaC0 3 + 2HCl==. 
2NaCl + H 2 S0 4 = Na 2 S0 4 + 2HC1. 

Sodium sulphate Hydrochloric acid. 

CaC0 3 + 2H01=CaCl 2 + C0 2 + H 2 0. 

Calcium chloride Carbon dioxide water. 

How would you determine, chemically, whether a uri« 
nary deposit were composed of urates or phosphates? 

Heat would dissolve a deposit of urates, but would not 
dissolve phosphates. 

Nitric acid would dissolve a deposit of phosphates, but 
would not dissolve urates. 

What is dialysis, and how would you construct a di- 
alyzer? 

Dialysis is the process of separating crystalloids from col- 
loids when both are in the same solution. 

It is performed in a dialyzer, which consists of a glass 
vessel, the bottom of which is formed of parchment or parch- 
ment paper, set in a larger vessel containing distilled water. 
The mixture is placed in the smaller vessel. 

In a short time the crystalloidal substances will have 
passed through the membrane into the distilled water, where 
they may be detected, and from which they may be separated 
by evaporation. The colloidal material remains in the dia- 
lyzer, not being able to pass through the membrane. 



CHEMISTRY. 245 

What is the difference between the mercurous and mer= 
curie chloride? 

Mercurous chloride, Hg 2 Cl 2 or 2HgCl. A white impalpable, 
insoluble powder, tasteless, odorless, turned black by am- 
monium hydroxide. Acts as a laxative. Has but slight 
poisonous action in single dose. 

Mercuric chloride, HgCl 2 . A white, crystalline, soluble 
substance, of a sweetish, burning, metallic taste, giving a 
white precipitate with ammonium hydroxide. Is very pois- 
onous; used externally as an antiseptic, and in concentrated 
solutions as a disinfectant; internally as an anti-specific, 
alterative, tonic. 

What impurities may be present in sulphuric acid, and 
how would you detect them? 

Lead. Appearing when strong sulphuric acid is diluted 
with water, as a white precipitate or haziness of sulphate 
of lead. 

Arsenic: Recognized by Marsh's test, 

Selenic acid: Showing its presence by communicating to 
the acid the power of dissolving gold. 

Nitric acid, or oxide of nitrogen: Detected by adding to 
the suspected acid a mixture of strong pure sulphuric acid 
and phenol, and evaporating in a porcelain dish to dryness, 
when on heating slightly, should nitrates or nitric acid be 
present, a pink coloration is observed. 

Organic matter in sulphuric acid causes a brown or black 
coloration. 

What is sulphuric ether, and what is its action upon 
man? 

It is the oxide of ethyl, (C 2 H 5 ) 2 0, or ordinary ether. It is 
a colorless liquid, lighter than water, readily vaporizing at 
ordinary temperatures, its vapor being heavier than air and 
of a characteristic odor. Ether produces in man, or other 
animals inhaling its vapor, unconsciousness and muscular re- 
laxation, and may occasion death, through a centric paralysis 
of respiration. 



246 CHEMISTRY. 

How would you detect the presence of bile in the urine? 

Float urine in test-tube, over yellow nitric acid; at point 
of contact, should bile be present, there will appear a band 
of colors, green, blue, violet, and red. 

Add cane-sugar to urine, and warm a drop or two of this 
mixture on a white porcelain surface; add a drop of strong 
sulphuric acid, when, should bile be present, there will ap- 
pear a play of colors forming in concentric rings, the colors 
particularly prominent being yellow, red and green. 

Give a reliable quantitative test for albumin. 

To a measured quantity of urine, add acetic acid to as- 
sure its acidity, boil, cool and filter through a weighed filter 
paper, wash the coagulated material with water containing a 
few drops of acetic acid, with ether, with alcohol, and again 
with boiling acidified water. Then dry at 212° F., and again 
weigh; deduct from this weight, weight of filter paper, and 
from result calculate the amount of albumin. Clinically 
albumin is determined by means of Esbach's albuminometer. 

What is mucin? How would you recognize it in urine? 

Mucin is a compound proteid, occurring in cement sub- 
stance of connective and epithelial tissues; in bile and in 
secretions of mucous surfaces. 

Test: It is not precipitated from urine by boiling, but is 
precipitated on the addition to urine of either alcohol, dilute 
mineral acids, acetic, picric or citric acids. To detect it add 
acetic acid to form a layer below urine without heating, when 
at point of contact a poorly defined line of precipitate will 
appear. 

Describe the usual method of determining chemically 
the presence of blood in the urine. 

To urine add a few drops of tr. guaiacum and then ozon- 
ized ether ; the ether separates and becomes of a fine sapphire- 
blue should blood be present. 



CHEMISTRY. 247 

Give a reliable quantitative test for sugar in the urine. 

In eacli of two bottles of about six ounces capacity place 
four ounces of urine, adding- to one of the bottles a small frag- 
ment of yeast. Stopper the bottles loosely and place in a 
warm place, allowing them to remain undisturbed for from 
12 to 24 hours and then again take the specific gravity. 
The loss in specific gravity in urine to which the yeast was 
added, multiplied by 0.2196, gives the percentage of sugar 
present. 

What is alcohol, and how is it formed? 

Alcohol is a compound of a hydrocarbon radical with 
hydroxyl, e. g., common alcohol, C 2 H 5 OH, formed by the 
fermentation of sugar. 

How is uric acid recognized chemically? 

Uric acid is recognized chemically by the murexid test: 
Evaporate with a few drops of nitric acid and to the residue 
add a drop of ammonium hydroxide — a fine purple color is 
obtained. 

Name the antidotes in a case of stramonium poisoning. 

Tannic acid, strong infusion of coffee, morphine, physo- 
stigmine, pilocarpine. 

What is the principal pigment in normal urine? 

Urobilin or urochrome. 

Give two chemical tests that you would use in water 
supposed to be contaminated by sewage. 

(a) Add to the water a drop or two of dilute sulphuric 
acid and enough potassium permanganate to give a decided 
pink color, cover the vessel with a glass plate, and if the pink 
color disappears inside of 10 minutes the water is probably 
contaminated. 

(b) Estimate the chlorides in the water, using a standard 
solution of silver nitrate with potassium chromate as an in- 
dicator. If the water contains an excessive quantity of 
chlorides the presence of sewage would be probable. 



248 CHEMISTRY. 

Give tests for the purity of chloroform. 

For Chlorine: Drop the suspected chloroform through a 
watery solution of potassium iodide in a test-tube. Should 
the chloroform acquire a pink color, and the supernatant 
liquid become yellow or brownish in tint, the presence of 
free chlorine is indicated. 

For HC1: Shake the chloroform with water, and after 
separating pour the water into a clean tube, and rendering 
it acid with a drop of nitric acid, add silver nitrate solution ; 
should hydrochloric acid or chlorides be present a white 
precipitate will form. 

For hydrocarbons: Evaporate suspected chloroform on 
clean porcelain surface, when no residue should be left, nor 
should there be any foreign odor. 

For water : Add to the chloroform white anhydrous copper 
sulphate; should the copper sulphate become blue in color 
the presence of water would be indicated. 

For acidity : By shaking the chloroform with water, pour- 
ing off the water and testing it with a drop or two of litmus 
solution, a red tint would indicate free acid. 

Explain the process of bleaching with chlorine. 

Chlorine bleaches organic colors only in the presence of 
moisture. Chlorine unites with the hydrogen of moisture, 
setting the oxygen free. In bleaching with chlorine we make 
use of a mixture of chlorinated lime and water. The fabric 
to be bleached is first "soured" by passing through a 
dilute acid solution. It is then placed in the bleaching mix- 
ture and afterward thoroughly washed with proper reagents 
to remove any excess of acid, chlorine or lime. 

State the most common and convenient antidotes for 
poisoning by mineral acids. State also the course to be 
pursued when the poison to be anti doted is unknown. 

Convenient antidotes for poisoning by mineral acids are : 
Calcined magnesia, and alkaline carbonates, as baking soda, 
chalk, and soap. Then use oils, fats, milk, flour, eggs. 



CHEMISTRY. 249 

If poison 'be of unknown character administer an emetic, 
as mustard and water, or use stomach pump or syphon tube. 
If reason to suspect poison to be of alkaloidal nature give 
tannic acid or permanganate of potassium. Milk with white 
of egg is a generally useful antidote for irritant poisons. 

Use ammonia, whiskey or strong coffee as stimulants, and 
meet symptoms as they arise. 

How would you make Fehling's solution? 

Prepare in 2 parts. I. 34.639 grammes pure crystalized 
copper sulphate dissolved in water and diluted to 500 Cc. 
II. 173 grammes Rochelle salt and 60 grammes sodium hy- 
droxide, dissolved in water and diluted to 500 Co. For use 
mix equal volumes of I. and II. Ten Cc. of the mixed solu- 
tion will be reduced by 0.05 gramme of glucose. 

What element composes over half the matter of the 
earth ? 

Oxygen. 

What is oxidation? 

Chemical union with oxygen. 

What is ozone? 

An allotropic form of oxygen, each molecule consisting of 
three atoms of oxygen. 

What is Paris green? 

A double salt of copper metarsenite and copper acetate. 
Cu(C 2 H 3 2 ) 2 .3Cu(As0 2 ) 2 . 

What is the chemical name of Rochelle salts? 

Potassium sodium tartrate, KNaC 4 H 4 6 . 

What is the chemical designation of the ordinary alco= 
hoi of commerce? 

Ethyl alcohol. 

From what substances is ether obtained? 

Ether results from distilling together sulphuric acid and 
ethyl alcohol. 



250 CHEMISTRY. 

Name the various states in which matter may exist. 

Solid, liquid, gaseous, and Crookes or radiant state. 

What is the difference between atomic weight and spe= 
cific gravity? 

Atomic weight is the relative weight of one atom of a 
substance as compared with the weight of an atom of some 
other substance taken as a standard. Specific gravity is the 
relation weight of one volume of a substance as compared 
with the weight of an equal volume of some other substance 
taken as a standard. 

Name and describe a deliquescent salt. 

Potassium carbonate, K 2 C0 3 , a white granular powder, 
odorless and having a strongly alkaline taste, very deliques- 
cent and very soluble in water, insoluble in alcohol. 

Complete the following equations: 

(a) 2NH 4 Cl+Ca(OH) 2 = 

(b) 2KN0 3 + H 2 S0 4 =. 

(a) 2NH 4 C1 +1 Ca(OH) 2 = CaCl 2 +' 2NH 3 + 2H 2 0. 

(b) 2KN0 3 + H 2 S0 4 = K 2 S0 4 + 2HN0 8 . 

Explain the reaction which occurs when the solution of 
the two parts of a seidlitz powder are mixed. 

Seidlitz powder consists of Rochelle salts, 120 grains ; sod- 
ium bi-carbonate, 40 grains; these are wrapped in the blue 
paper. 

In the white paper is placed 35 grains of tartaric acid. 

H 2 C 4 H 4 6 + 2NaHC0 3 = Na 2 C 4 H 4 6 + 2H 2 + 200 2 . 

To what salts do most cathartic mineral waters owe 
their virtues? 

To magnesium sulphate, or to sodium sulphate. 

Explain the construction of the safety lamp used by 
miners, and state the principle involved. 

The flame of the lamp is surrounded by a fine wire gauze, 
the mesh of which is very small. Each individual mesh con- 



CHEMISTRY. 251 

tains its film of air, and as air is a poor conductor of heat, 
the transmitted heat of the flame is decreased below the 
ignition point. 

What is pepsin? 

A proteolytic ferment or enzyme obtained from the glandu- 
lar layer of the fresh stomach of the hog — the principal fer- 
ment of gastric juice. A yellowish or greyish-white powder, 
soluble in water and glycerin, but insoluble in alcohol. 

Mention the antidote applicable in case of poisoning 
from silver nitrate. 

Common salt, NaCl. 

What is a chemical symbol? 

An abbreviation for the name of an element. 

What is the chemical composition of ordinary alum? 

Alum is a double sulphate of aluminum and potassium. 
Its formula is Al 2 (SOJ 3 K 2 S0 4 . 24H 2 0, or, (U. S. P.), 
A1K(S0J 2 12H 2 0. 

Write the formula of (a) common salt, (b) nitric acid, 
(c) sulphuric acid, (d) hydrochloric acid, (e) . carbonic an= 
hydride. 

(a) NaCl; (b) HN0 3 ; (e) H 2 S0 4 ; (d) HC1; (e) C0 2 . 

What is the simplest test of the presence of (a) an 
acid, (b) iodine? 

(a) Turns litmus paper red; (b) turns starch mucilage 
bluish-black. 

Complete the following reactions: 

CaCL, + Na o C0 8 = 

(C 2 H 5 )HO + C 2 H 5 HS0 4 =. 

CaCL + Na 2 C0 3 = CaC0 3 + 2NaCl. 

(C 2 H 5 )HO + C 2 H 5 HS0 4 =(C 2 H 5 ) 2 + H 2 S0 4 . 

Mention a test for ozone. Explain how ozone may be 



-'52 CHEMISTRY. 

prepared in the laboratory, and compare its properties 
with those of oxygen. 

Gives a dark blue color to paper that has been wet with 
iodide of potassium and starch mucilage. Ozone is prepared 
by subjecting air or oxygen to silent electric discharges, as 
in the "Siemens" induction tube, or by the slow oxidation of 
moist phosphorus. 

Its properties are similar to those of oxygen, save that it 
acts more vigorously as an oxidizing agent and in concen- 
trated form is irrespirable. 

Name four elements that enter into the formation of 
organic bodies. 

Carbon, hydrogen, oxygen, nitrogen. 

What preparation of gun cotton is used in medicine, 
and what is its solvent? 

Pyroxylin. 'Soluble in 25 parts of a mixture of 3 volumes 
of ether and 1 volume of alcohol. 

How may uric acid be obtained from urine? 

By adding to the urine strong hydrochloric acid, when 
after the mixture has stood from 12 to 24 hours uric acid 
will appear in minute crystals. 

Mention the antidotes applicable in cases of poisoning 
from zinc chloride. 

Albumin, white of egg in milk, magnesia in milk, tannin. 

Mention the elements that, under ordinary circum= 
stances, exist as (a) liquids, (b) gases. 

(a) Bromine and mercury, (b) Oxygen, hydrogen, nitro- 
gen, chlorine, fluorine, argon. 

Give the preparation, formula, properties and uses of 
potassium cyanide. 

Potassium cyanide, KCN. Prepared by saturating potas- 
sium hydroxide with hydrocyanic acid. A white amorphous 
-deliquescent salt, easily fusible, and smelling of cyanogen. 



CHEMISTRY. 253 

Very soluble in water, highly poisonous, used in electro- 
plating, in metallurgy, and medicinally, as a cardiac seda- 
tive, as a sedative addition to cough mixtures in gastralgia,. 
reflex headaches, nervous vomiting, etc. 
Define valence, radical. Illustrate. 

By valence we refer to that property by virtue of which 
an element or radical will hold in combination a certain 
number of atoms of another kind. Thus oxygen has a val- 
ence of two, as shown in water, H 2 0. 

A radical is an atom or group of atoms incapable of exist- 
ing in an uncombined state. E. g. (SOJ a radical with 
valence of II. occurring in sulphuric acid, H 2 S0 4 , and in 
sulphates. 

What is the formula of carbolic acid? 

C 6 H 5 OH. 

How may phosphorus be obtained? Describe the al!o= 
tropic forms of phosphorus. 

To bone-ash add sulphuric acid and water; after stand- 
ing 24 hours decant the liquid, evaporate it to dryness and 
heat the residue strongly; to this result add sand and char- 
coal and distil, receiving the resultant phosphorus vapor un- 
der water, where it solidifies. 

Ordinary phosphorus is a translucent wax-like solid, lumin- 
ous in the dark, poisonous, insoluble in water, slightly soluble 
in alcohol, soluble in oils and in carbon disulphide. Red or 
amorphous phosphorus is a reddish brown amorphous powder, 
not luminous in the dark, not poisonous, insoluble in oils and 
in carbon disulphide. There is also a "metallic" form of 
phosphorus occurring in black, needle-like crystals. 

Give the formula and chemical name of each of the 
following substances, indicating those soluble in water; 
Nitre, Epsom salts, lunar caustic, aqua fortis, Paris green, 
gypsum. 

Nitre, potassium nitrate, KN0 3 , soluble. Epsom salts, mag- 



254 CHEMISTRY. 

nesium sulphate, MgS0 4 , soluble. Lunar caustic, silver ni- 
trate, AgN0 3 , soluble. Aqua fortis, nitric acid, HN0 3 , 
soluble. Paris green, cupric acetometarsenite, Cu(C 2 H 3 2 ) 2 : 
3Cu(As0 2 ) 2 , insoluble. Gypsum, calcium sulphate, CaS0 4 ,- 
2H 2 0, insoluble. 

What is the chemical designation of nitroglycerin? 
How is nitroglycerin manufactured? 

Glyceryl trinitrate, C 3 H 5 (N0 3 ) 3 . Nitroglycerin is made 
by cautiously adding glycerin to a mixture of strong nitric 
and sulphuric acids. 

What are amins? Give an example. 

They are substances which result when the hydrogen of 
ammonia is replaced by hydrocarbon radicals. 

Example : When NH 3 has one hydrogen atom replaced by 
C 2 H 5 it forms NH 2 C 2 H 5 , ethyl amin. 

Define porosity, capillary attraction. 

Porosity refers to that essential property of matter by 
virtue of which spaces called pores exist between the mole- 
cules of all substances. Capillary attraction is the exhibi- 
tion of the property of adhesion, between the molecules of a 
liquid and the material of a tube, rod or surface wetted by 
it, shown most characteristically in the rise of liquids in 
small (capillary) tubes. 

How do chemical antidotes and physiologic antidotes 
differ in action? Illustrate. 

A chemical antidote forms an insoluble or harmless sub- 
stance by combining chemically with the poisonous substance ; 
thus magnesium sulphate is antidotal to soluble salts of lead, 
as it combines chemically with lead to form the insoluble 
sulphate. A physiologic antidote acts, not directly upon the 
poisonous body, but by producing a physiologic action op- 
posed to that which the poison occasions; thus we use atro- 
pine as the physiologic antidote to morphine. 



CHEMISTRY. 255 

Mention two elements of each of the following groups: 
Univalent, bivalent, trivalent, quadrivalent. 

Univalent: Hydrogen and chlorine. 
Bivalent: Oxygen and magnesium. 
Trivalent: Arsenicum and boron. 
Quadrivalent: Silicon and platinum. 

What is the difference between analytic methods and 
synthetic methods in chemistry? 

Analytical methods seek to break down compounds into 
simpler bodies. 

Synthetic methods seek to build up compound bodies by 
the union of simpler ones. 

What gases are usually generated during the process of 
destructive distillation? 

If the destructive distillation be of soft coal, we find among 
the gases resulting hydrogen, marsh gas, defiant gas, acety- 
lene gas, ammonia, sulphuretted hydrogen, carbon monoxide 
and carbon dioxide. 

Describe sulphur, and mention its important compounds. 

Sulphur: symbol S, atomic weight, 32, (31.83), valence II., 
IV., found free, in volcanic regions, and in combination in 
form of sulphates and sulphides. It is a lemon-yellow solid 
element. No taste or odor. It is strongly electro-negative, 
is non-metallic, resembles oxygen in its chemical combinations. 
It is insoluble in water, slightly soluble in hot alcohol, freely 
soluble in carbon disulphide. 

Important ^compounds are, sulphur dioxide, sulphurous 
acid, sulphuric acid, sulphur iodide, and hydrosulphuric acid. 
Combined with metals we have many important sulphates, 
sulphites, and sulphides. 

What is boron? Give its principal compounds. What 
is the chemical importance of boron in medicine? 

Boron: symbol, B, atomic weight, 11(10.9) valence III., is 
a rare, solid, non-metallic element, important because of its 



256 CHEMISTRY. 

principal compounds, boric acid H 3 B0 3 , and borax or sodium 
borate, Na 2 B 4 7 , both of which are antiseptic, mildly astrin- 
gent and detergent. 

Describe the incandescent electric light, and explain its 
use as an aid to diagnosis in medical and surgical practice. 

The incandescent electric light consists of a thin glass bulb 
exhausted of air and containing a filament of carbon or 
platinum wire coiled in semicircle or other design. On passing 
a current of electricity this filament, because of the resistance 
it offers, becomes incandescent, thus giving light. 

The incandescent electric light has considerable value in 
medicine and surgery for illuminating passages which can- 
not be directly lighted ; thus we use it in the examination of 
larynx; in the form of the 'Cystoscope, in the bladder. It 
is used also to illuminate the interior of the stomach, thus 
facilitating the examination of this organ. 

Give the composition and properties of chloroform. 

Chloroform, CHC1 3 , is a colorless, heavy, volatile liquid, 
with specific gravity about 1.5 and a characteristic sweet- 
ish odor. It is soluble in 200 parts water and freely soluble 
in alcohol, ether, and oils. Used for producing general 
anesthesia, and as a solvent. 

Complete the following equation and give the resulting 
compounds: 

2C 2 H 3 K0 2 + H 2 S0 4 = 

2C 2 H 3 K0 2 + H 2 S0 4 = K 2 S0 4 + 2HC 2 H 3 2 . 

Potassium sulphate. Acetic acid. 

What organic acids are present in vegetables and fruits? 

Citric acid, malic acid, tartaric acid, oxalic acid, gallic 
acid, tannic acid, etc. 

Describe and illustrate the distinction between organic 
and inorganic compounds. 

Inorganic compounds occur in the mineral kingdom, and 



CHEMISTRY. 257 

may contain any of the elementary forms of matter; the 
number of atoms in the molecule of inorganic compounds is 
usually small. Examples: Sodium chloride, magnesium sul- 
phate. 

Organic compounds all contain carbon, combined with one 
or more of the following — oxygen, hydrogen, nitrogen, sul- 
phur and phosphorus — there are frequently many atoms pres- 
ent and the molecules are often complex. Examples : Starch, 
albumin. 

Give the chemical composition of (a) Glauber's salt, 
(b) Epsom salt. 

(a) Sodium sulphate, Na 2 S0 4 . (b) Magnesium sulphate, 
MgS0 4 . 

Into what two principal groups are elements divided? 
Mention five elements that exist uncombined in nature. 

Into the electro-positive metals and the electro-negative 
non-metals. Oxygen, nitrogen, sulphur, gold, silver. 

Mention the acid constituent of bile. 

Taurocholic and glycocholic acids. 

What is hemoglobin? On what does its color depend? 

It is the organic coloring principle of red blood corpuscles, 
a compound of the iron-holding substance hematin and the 
proteid substance globin. 

Its color depends upon its degree of oxidation, oxyhemo- 
globin in mass giving a scarlet, hemoglobin, a bluish red. 

Differentiate nitrates and nitrites. Mention two com= 
pounds of each group commonly used in medicine. 

Nitrates are salts of nitric acid and contain the radical 
N0 3 . Nitrites are salts of nitrous acid and contain the 
radical N0 2 . Examples : Potassium nitrate, KN0 3 , lead ni- 
trate Pb(N0 2 ). Sodium nitrite, NaN0 2 , amyl nitrite 
C 5 H n N0 2 . 
17 



258 CHEMISTRY. 

What reaction takes place when chloral hydrate is 
mixed with an alkali? Illustrate. 

There results chloroform, a metallic formate and water. 
CCl 3 COH.H 2 + KOH = CHC1 3 + KCOOH + H 2 0. 

What salt of mercury is soluble in water? Give the 
name and formula of a salt of silver used in medicine. 

Mercuric chloride, HgCl 2 . Silver nitrate, AgN0 3 . 

Describe the test for detecting the presence of strych= 
nine. 

Dissolve a crystal of the alkaloid in a drop of strong sul- 
phuric acid on a watch-glass, and drag through the solution 
by means of a glass rod a fragment of potassium dichromate, 
a play of colors will be produced — dark violet-blue, purple, 
cherry-red, and reddish yellow. 

What is a hydrocarbon? 

A hydrocarbon is an organic compound, the molecule of 
which consists of carbon and hydrogen atoms only. 

What is the faradic current? How is it produced? 

The faradic current is an induced current of electricity 
obtained by use of an induction coil. An induction coil is 
constructed as follows: A small coil of large diameter wire 
is surrounded by a coil of longer and much thinner wire. 
An interrupted current of electricity from a battery is sent 
through the inner (primary) coil — with each "make" and 
"break" of this primary current a secondary current is in- 
duced in the outer (secondary) coil. This secondary, in- 
duced, interrupted current is the Faradic current. 

What is synthesis? Mention three coal=tar products 
extensively used in medicine that are prepared in the 
chemical laboratory by synthesis. 

Synthesis is the act of constructing a compound body from 
its component parts. Synthetical compounds used in medi- 
cine obtained from coal tar include salicylic acid, phenacetine, 
saccharin. 



CHEMISTRY. 259 

Differentiate a mass of matter, a chemical compound 
and an elementary body. 

An elementary body is a substance that cannot be reduced 
to any simpler form, that is, it contains but one kind of 
atom. A chemical compound is the result of the chemical 
union of two or more elementary bodies. A mass of matter 
is an aggregation of either elementary or compound molecules. 

Explain the following terms: Chemical reaction, alka- 
line reaction. 

Chemical reaction refers to the interchange of atoms or 
radicals which occurs during a chemical change. A sub- 
stance is said to have an alkaline reaction when it changes 
red litmus to blue. 

Describe some method for (a) analysis of water, (b) the 
synthesis of water. 

(a) Pass water in the form of steam through an iron pipe 
heated to redness, — the oxygen will enter into chemical union 
with the iron, forming magnetic oxide of iron, Fe 3 4 , and 
hydrogen will issue from the distal end of the pipe. 

(b) Pass dry hydrogen over copper oxide placed in a hard 
glass tube and heated to redness, — the hydrogen will enter 
into chemical combination with the oxygen, and vapor of 
water will issue from the distal end of the tube. 

State the chemical properties of carbon. Describe two 
allotropic forms of carbon. 

Carbon: symbol C, atomic weight, 12(11.91), valence. II., 
IV., an electro-negative solid element. It resists the action of 
most reagents but, at high temperatures, combines readily 
with oxygen to form two oxides, carbon monoxide and carbon 
dioxide. Combines with hydrogen to form many bodies 
known in organic chemistry as hydrocarbons. It forms bin- 
ary combinations with most non-metals and with a few 
metals. It is non-poisonous. 

An allotropic form of carbon is graphite ; an opaque, grey- 



260 CHEMISTRY. 

ish-black substance crystallizing in hexagonal plates used as 
a lubricant,, for making .crucibles, lead pencils, etc. Diamond, 
another allotropic form of carbon, occurs in transparent octa- 
hedral crystals, of high refracting power, is the hardest sub- 
stance known, and is insoluble in all liquids. 

Mention the principal constituents of muscle. 

Water about 75 per cent, and solids about 25 per cent. 
The characteristic solid is myosinogen belonging to the class 
of globulins. Other substances are creatine, creatinine, gly- 
cogen, glucose, lactic acid, sarcine, adenine, etc. The chief 
mineral constituent present is potassium phosphate. 

How is the air of an apartment tested to determine the 
presence and amount of carbon dioxide in it? 

A measured volume of air is drawn through two weighed 
tubes; the first, containing calcium chloride, absorbs the 
moisture, the second, containing potassium hydroxide, absorbs 
the carbon dioxide. By the increase in weight of the 
second tube the amount of carbon dioxide in the air may be 
determined. 

Give names and formulas of the salts of iron commonly 
used in medicine. 

Ferrous carbonate, FeC0 3 ; ferrous iodide, Fel 2 ; ferrous 
sulphate FeS0 4 ; ferrous lactate, Fe(C 3 H 5 3 ) 2 . Ferric 
chloride, Fe 2 Cl 6 ; ferric hydroxide, Fe 2 (OH) 6 ; ferric sul- 
phate, Fe 2 (SOJ 3 ; ferric alum, Fe 2 (S0 4 ) 3 (NH 4 ) 2 S0 4 .24H 2 ; 
ferric nitrate, Fe 2 (N0 3 ) 6 ; ferric phosphate, Fe 2 (P0 4 ) 2 ; ferric 
pyrophosphate, Fe 4 (P 2 7 ) 3 . There are, also, the so-called 
scale compounds, salts of iron, of iron and ammonium, of 
iron and potassium and of iron, quinine and strychnine, with 
citric and tartaric acids. 

Mention two salts of mercury commonly used in medU 
cine. Give their formulas. 

Mercuric chloride HgCl 2 . 

Mercurous chloride Hg 2 Cl 2 , or 2HgCL 



CHEMISTRY. 261 

What conditions favor putrefaction? What conditions 
may prevent putrefaction in dead organisms? 

Presence of moisture, warmth, and bacteria. Putrefaction 
may be prevented by the exclusion of bacteria, by exclusion 
of moisture, by the preservation of low temperatures, and by 
the use of germicides. 

Give source, character and uses of atropine. Describe 
the symptoms of poisoning by atropine. 

Atropine is an alkaloid obtained from belladonna, A white, 
crystalline powder soluble in 450 parts of water and in 1.46 
parte of alcohol. Solutions are alkaline in nature. Typical 
symptoms produced are dilatation of pupil of eye, dryness 
of throat, flushing of face, talkative delirium ; later paralysis 
of centric origin. Pulse at first slow, hard; later soft and 
dicrotic, rapid. 

Give the properties of common alum. 

It is a white odorless crystalline substance of a sweetish, 
strongly astringent taste, a mechanical emetic. It is soluble 
in cold water, more soluble in hot water, insoluble in alcohol. 

Heated, it loses its water of crystallization forming the so- 
called exsiccated alum. 

What metallic chemical elements are found in the body 
in various combinations? 

Iron, magnesium calcium, potassium and sodium. 
Differentiate hydracids and oxyacids. 

A hydracid is an acid containing no oxygen. An oxyacid 
is an acid containing oxygen. 

Give the chemistry of lithium. 

Lithium, symbol Li, atomic weight, 7 (6.98), valence I., 
occurs in nature as the chloride, carbonate, and phosphate. 
A soft silvery-white metal, sp. gr. 0.589, oxidizes on ex- 
posure to air, decomposes water, setting the hydrogen free. 
A member of the alkali group of metals. 



262 CHEMISTRY. 

What is the principal source of urea in the human 
economy? 

Urea is the result of the oxidation of nitrogenous tissues; 
it is the end product of normal nitrogenous metabolism. 

Give the formula of ammonium chloride. Describe the 
method of preparing ammonium chloride. 

Ammonium chloride, NH 4 C1. It is prepared by saturating 
ammonium hydroxide with hydrochloric acid, and evaporat- 
ing the solution. 

Give the chemical name and properties of (a) cream of 
tartar, (b) plaster of Paris. 

(a) Potassium-hydrogen tartrate or potassium bitartrate, 
KHC 4 H 4 6 occurs in colorless crystals or as a white powder 
permanent in air, soluble in 200 parts water ; very sparingly 
soluble in alcohol, is crysitallizable white salt, soluble in water. 

Calcium sulphate, CaS0 4 , a fine white, odorless and taste- 
less powder, nearly insoluble in water. Mixed with one-half 
its weight of water it forms a paste which hardens to a 
firm plaster. 

Give the physical and chemical properties of hydro= 
chloric acid. How is hydrochloric acid prepared? 

Hydrochloric acid HC1, is a colorless gas, soluble in water. 
In this form, when pure, it occurs as a colorless liquid, fum- 
ing in air, with caustic and corrosive action upon organic 
tissues. Specific gravity is about 1.2. 

It is a monobasic hydracid, and in union with bases forms 
salts called chlorides nearly all of which are soluble in water. 

Hydrochloric acid may be prepared by heating sodium 
chloride with sulphuric acid. 

Describe Fehling's test for sugar in urine. 

Fehling's test: Dilute the Fehling's solution with three 
volumes of water, heat to boiling — the solution should re- 
main clear — and then, to the hot solution, add the urine 
drop by drop. A yellowish red precipitate of cuprous hy- 
droxide and oxide indicates the presence of glucose. 



CHEMISTRY. 263 

Complete the following reaction: 

PC1 3 + 3H 2 = 

PCI3 + 3H 2 = H 3 P0 3 + 3HC1. 
How are the phosphates produced in the animal body? 

The phosphates exist ready formed in plant foods, as 
in wheat. They are also found in the animal tissues that af- 
ford food for the human subject. 

Give the symbol, atomic weight and the occurrence in 
nature of bismuth. 

Symbol, Bi. Atomic weight, 207(206.9). Occurs native 
and as the sulphide, frequently associated with arsenic. 

Give the formulas of the nitrogen acids. How is nitro= 
gen prepared in the laboratory? 

Hyponitrous acid, HNO. Nitrous acid, HN0 2 . Nitric 
acid, HNO3. 

Nitrogen is prepared by burning phosphorus in a confined 
space until the oxygen is all removed, or, by heating ammon- 
ium nitrite. NH 4 N0 2 + heat = N 2 + 2H 2 0. 

Give chemical name of (a) common table salt, (b) soot, 
(c) vinegar, (d) verdigris. 

(a) Sodium chloride, (b) Carbon, (c) Dilute acetic 
acid, (d) Basic cupric acetate. 

What reaction of urine favors the deposition of uric 
acid gravel or calculi? What is the reaction of the urine 
during the formation of a phosphatic calculus? 

(a) A strongly acid reaction, (b) An alkaline reaction. 

What is nitroglycerin? Give the medical properties of 
nitroglycerin. 

Nitroglycerin is, chemically, glyceryl trinitrate C 3 H 5 - 
(N0 3 ) 3 . Made b T the action of nitric acid on glycerin, in 
the presence of strong sulphuric acid — is glycerin in which 
three hydrogen atoms have been replaced by three N0 3 
radicals. 



264 CHEMISTRY. 

It is used medicinally in a one per cent, alcoholic solution, 
as a vasodilator, to relieve heart tension by lowering the 
blood pressure. 

What is (a) starch, (b) dextrin? 

(a) Starch, C 6 H 10 5 , is a white odorless, tasteless carbo- 
hydrate, insoluble in ether, alcohol, or cold water, forming 
a colloidal mucilaginous mass in hot water. Found in all 
plants, most abundantly in the root, soft parts, and seeds. 

(b) Dextrin, C 6 H 10 O 5 , isomeric with starch, may be pro- 
duced from it by the action of dry heat, by the action of 
ferments, and by the action of dilute acids. An amorphous 
substance insoluble in ether or alcohol but soluble in cold 
water. 

Describe and state the uses of the thermometer, the 
barometer and the hygrometer. 

A thermometer is a capillary tube containing mercury 
hermetically sealed, with a bulb at the lower end and a gradu- 
ated stem above. It is used to determine the degree of 
temperature by the expansion of the mercury in the tube. 

A barometer is an instrument for measuring atmospheric 
pressure. Fill a long glass tube sealed at one end, with 
mercury and invert it in a cup of mercury. The mercury 
in the tube will fall until its weight is just balanced by the 
atmospheric pressure. Ordinarily the height of the mer- 
cury column will be about 30 inches. As the 'atmospheric 
pressure lessens, the mercury falls, as the atmospheric pres- 
sure becomes greater, the mercury rises. 

A hygrometer is used to determine the degree of humidity 
of the atmosphere. The most usual form of instrument is 
that known as the "Dry and Wet Bulb" — two thermometers, 
side by side, the bulb of one exposed to the air, the bulb of 
the other kept constantly wet by threads of cotton dipping 
in a compartment containing water. The drier the air the 
greater the difference in temperature reading between the two 
instruments. Tables have been prepared by which the exact 
humidity of the atmosphere may be determined. 



CHEMISTRY. 265 

Explain the method of producing X or Roentgen rays. 

The X or Roentgen rays are produced by passing a current 
of electricity of high potential through a glass tube that has 
been, as far as possible, exhausted of air. 

(a) Express in cubic centimeters of distilled water the 
value of one ounce avoirdupois, (b) How many minims 
does a cubic centimeter contain? 

(a) 28.3 Ce. (b) 16.2 minims. 

What is hydrogen sulphide? Show by formulas and 
equation how it is obtained by the action of hydrochloric 
acid on calcium sulphide. 

A compound of sulphur and hydrogen, H 2 S, a colorless 
gas of offensive odor. 

CaS + 2HC1 = CaCl 2 + H 2 S. 

What salt forms the tartar deposited on the teeth? 
From what source is the tartar derived? 

Chiefly calcium phosphate, with a little calcium carbonate, 
and salts of the alkalies. These salts are mixed with silica, 
organic matter and bacteria. The tartar is derived from 
food residues and from the saliva. 

What are the properties of antimony? How is it found 
in nature? 

Antimony: symbol, Sb, atomic weight 119 (119.3) valence, 
III., V., is a bluish-white, brittle, crystalline metal. Ignites 
at a red heat forming Sb 2 3 . 

Used chiefly in alloys, it increases hardness, lowers fusion 
point, gives smoother surface, causes expansion of alloy when 
•cooled after fusion, gives rigidity to soft metals. Antimonv 
occurs in nature chiefly as the sulphide. 

(a) What is an amorphous substance? (b) What are 
isomorphous substances? 

(a) A substance, not 'Crystalline having no regularity of 
internal structure, (b) Substances which crystallize in the 
same form. 



266 CHEMISTRY. 

Give uses of the urinometer. State its importance as 
an aid to diagnosis. 

It is used to determine the specific gravity of the urine. 
Taken into consideration with the amount of urine passed, it 
indicates the amount of solid matter being excreted by the 
kidney. Certain diseases present a lessened excretion of 
solids, others an increased excretion; the determination of 
this factor, then, may be of importance in deciding upon the 
condition actually present. By it we learn of the condition 
of the kidney function and also of the body metabolism. 

Describe potassium. 

Potassium: symbol, K, atomic weight, 39(38.86), valence 
I., a soft silver- white metal, oxidizing in the air, and de- 
composing water in the cold with liberation of hydrogen gas 
and the formation of potassium hydroxide. It melts below 
the boiling point of water, is lighter than water, and is one 
of the most electro-positive of metals. 

Write a chemical equation showing a double decompo- 
sition. 

AgN0 3 + HC1 = AgCl + HN0 3 . 

Give the physical and chemical properties of mercury. 
How is mercury obtained from the native ore? 

Mercury: symbol, Hg; atomic weight, 198.5; valence, II; is 
a silver-white metal liquid at ordinary temperatures, 13% 
times heavier than water; it is volatile at all temperatures, 
opaque, insoluble in water, soluble in nitric acid. Chem- 
ically, it is electro-positive, and capable of forming two dis- 
tinct classes of compounds — the mercurous and the mercuric. 
It forms alloys (amalgams) with most metals. Mercury is 
obtained from cinnabar, HgS, by roasting the ore, thus burn- 
ing out the sulphur and distilling over the mercury. 

Define decay. 

Decay refers, generally, to the slow oxidation, resulting 
in the decomposition of organic substances. 



CHEMISTRY. 267 

Describe distillation, filtration and precipitation as ap= 
plied to processes for purifying drinking water. 

There are two forms of distillation practiced, the continu- 
ous and the intermittent. In continuous distillation the 
water is fed constantly into the retort, and the distillate con- 
tains the gases and volatile products produced from the 
organic matter present. Such a water acquires a disagree- 
able odor and taste on standing, but is of course free from 
germ life. In intermittent distillation a given amount of 
water is introduced into the retort, the first part of the dis- 
tillate is rejected, this containing the volatile organic pro- 
ducts, then a middle portion is saved, and the final portion 
left in the retort is rejected. By this process we get a pure 
water which requires, however, to be aerated to be palatable. 

Filtration on a large scale is through beds of sand and 
gravel. Suspended matter is removed and bacteria are 
largely destroyed. On a small scale filtration is generally 
through porcelain, suspended matter and bacteria are held 
back by the smallness of the interstices in the filtering me- 
dium. Such filters must be frequently and thoroughly 
cleansed. 

Precipitation is effected by the addition to the water of 
one or more substances which shall produce a voluminous, 
more or less gelatinous, precipitate. In this will be carried 
down the suspended matter and the major part of the germ 
life. Iron salts, and alum, are among the chemicals gener- 
ally used. 

What is freezing? State the Fahrenheit freezing point 
of (a) water, (b) alcohol, (c) mercury. , 

Freezing is the change of a liquid to a solid upon the 
lowering of temperature. 

(a) 32° F. (b) — 40° F. (c) 202.9° F. 

Complete the following equation: 

C,H 5 OH + NaC 2 H 3 2 + H 2 S0 4 = 

C 2 H s OH + NaC 2 H 3 2 + H 2 SO, — C 2 H,C 2 H 3 2 4- NaHSO, + H 2 0. 



268 CHEMISTRY. 

Explain the difference between a sulphate and a sul= 
phite. 

A sulphate is a salt of sulphuric acid and contains the 
acidulous radical, S0 4 . 

A sulphite is a salt of sulphurous acid 'and contains the 
acidulous radical, S0 3 . 

Name the elements in the potassium group, and give 
their physical and chemical properties. 

Lithium, sodium, potassium, and the rare metals, rubidium 
and caesium. 

All are white metals, the softest being but little harder than 
wax. They melt below the boiling-point of water, oxidize in 
air, decompose water liberating hydrogen. All are strongly 
electro-positive, forming strong alkaline bases — oxides and 
hydroxides. E.ach communicates a distinctive color to flame 
when incandescent. All are monads, their carbonates all 
vaporize unchanged when heated. The carbonates and phos- 
phates of all ;are freely soluble in water. 

Describe the element silver, stating its compounds and 
their uses in medicine. 

Silver: symbol, Ag, atomic weight 107 (107.12), valence I., 
a pure white metal, ductile and malleable, the best conductor 
of heat and electricity. Specific gravity 10.5. 

Silver wire is used in surgery. 

The compounds used in medicine are the oxide, nitrate, 
the cyanide and iodide. The nitrate is used in the solid 
state as a stimulant and caustic, and, internally, in solution, 
as an astringent and alterative especially in stomach and 
bowel disturbances. 

Name five compounds of nitrogen and oxygen, and give 
their formulas. 

Nitrous oxide or nitrogen monoxide, N 2 ; nitric oxide or 
nitrogen dioxide, N 2 2 ; nitrous anhydride or nitrogen tri- 
oxide, N 2 3 ; nitric anhydride or nitrogen pentoxide, N 2 5 ; 
nitric peroxide or nitrogen tetroxide, N0 2 . 



CHEMISTRY. 269 

What is the presumption as to abnormal constituents in 
urine having a specific gravity of 1005 or less? What 
tests should be applied, and how, to verify the surmise? 

It indicates a greatly decreased excretion of solids by the 
kidneys or an excessive polyuria ; this may be due to lack of 
nervous control over excretory function of kidney, as in 
hysteria, chorea, etc., or it may be from large imbibition of 
fluids. It may be due to diseased conditions of kidney with 
destructive changes in structure. Such a low specific grav- 
ity always calls for a careful examination for albumin, which, 
if present and accompanied by urinary casts, would indicate 
a structural disease of the kidneys. Tests for albumin have 
been given. 

What are the differences between common alcohol and 
absolute alcohol? 

Absolute alcohol contains not more than 1 per cent, of 
water and this is in chemical combination with the alcohol. 
Sp. gr. not higher 'than 0.797 at 15.6° C. 

Common alcohol contains about 7.7 per cent, of water, 
partially in mixture and partially in combination with the 
alcohol. Sp. gr. about 0.816 at 15.6° C. 

Complete the following equations: 

C 2 H 5 C1 + AgHO = 

CaC0 3 + 2HCl=. 

C 2 H 5 C1 + AgHO = AgCl + C 2 H 5 OH. 

OaC0 8 + 2HC1 = CaCl 2 + H 2 6 + C0 2 . 

What are the physical and chemical properties of S0 2 ? 

It is a heavy colorless gas, dissolving in and chemically com- 
bining with water to form sulphurous acid. It has a suffo- 
cating, irrespirable odor, can be liquefied and solidified. It 
will not support combustion nor will it burn. It has a power- 
ful affinity for moisture, forming, therewith, sulphurous acid. 
Sulphur dioxide is useful as a bleaching agent and as a 
disinfectant. 



270 CHEMISTRY. 

What is reduced iron (ferrum redactum) and how is it 
obtained? 

It is a chemically pure form of iron occurring in fine 
powder. It is obtained by passing dry hydrogen gas over 
heated ferric oxide in a tube. 

Describe ethyl oxide, giving derivation, ordinary name, 
chemical formula and mode of production. 

Ethyl oxide, ordinary ether, (C 2 H 5 ) 2 0, is obtained by the 
replacement of two hydrogen atoms in a molecule of water 
by two ethyl radicals. It is manufactured by distilling a 
mixture of alcohol and sulphuric acid. 

C 2 H 5 OH + H 2 S0 4 = C 2 H 5 HS0 4 + H 2 ; 

C 2 H 5 HS0 4 + C 2 H 5 OH— (C 2 H 5 ) 2 + H 2 S0 4 . 

What is the presumption as to abnormal constituents in 
urine having a specific gravity of 1038? 

Such urine will probably be found to contain glucose. 

Give an equation showing the reaction when NH 3 comes 
in contact with an acid. 

NH 3 + HC1 = NH 4 C1. 

Define emulsion, soap. 

An emulsion is a liquid holding in suspension oil in so finely 
divided a condition, that the individual drops are invisible 
to the naked eye. There is generally required to be present 
a substance of mucilaginous nature. 

A soap is 1a metallic salt of a fat acid. It is usually a 
potassium or sodium salt of oleic, stearic or palmitic acid. 

Give the sources and explain the uses of benzene. 

C 6 H 6 , benzene. It is found in the lighter oils produced 
in the distillation of coal tar. 

It is used as a solvent for fats, oils, resins, and many 
other organic substances. Used in medicine as an anti- 
spasmodic and anti catarrhal remedy. 



CHEMISTRY. 271 

What is an alkaloid? Name three alkaloids used in 
medicine. 

An organic nitrogenous substance, basic in character, cap- 
able of combining directly with acids to form salts. The 
volatile alkaloids contain carbon, hydrogen, and nitrogen; 
the non-volatile alkaloids contain carbon, hydrogen, nitrogen 
and oxygen. Examples : strychnine, quinine, and morphine. 

State the chemical meaning of the term incompatible. 

Chemically, substances are incompatible when on mixing 
their solutions there results an insoluble body, or a new sub- 
stance having markedly different properties ; or when two or 
more substances, in themselves harmless, form a poisonous, 
explosive, or inflammable substance when brought in contact ; 
or if bringing them together impairs in any other way their 
individual characteristic properties. 

State the use and the principle underlying the use of 
the blow=pipe. 

The blow-pipe serves to provide, and to concentrate at a 
particular point, a jet of flame of extremely high temper- 
ature, this high temperature being attained by the perfect 
combustion resulting from the mixing of the air with gas be- 
fore the latter burns. 

Define electricity. 

Electricity is that physical force generated by chemism, 
magnetism or friction, which manifests itself by producing 
attraction or repulsion between certain substances, and gives 
rise to heat, light, magnetism, and chemical action. 

(a) In what compound is sodium most abundant? (b) 
In what calcium? (c) In what hydrogen? 

(a) Sodium chloride, (b) Calcium carbonate, (c) Water. 
What is glycerin and how is it obtained? 

Glycerin, C 3 H s 3 , or C 3 H 5 (OH) 3 . It is a tri-atomic al- 
cohol derived from propane, C 3 H 8 . Made by decomposing 



272 CHEMISTRY. 

fat either by means of superheated steam, or by heating the 
fat with an alkali. 

Explain the difference between a galvanic and a faradic 
current. 

A galvanic current results from chemical action, and has 
but low potential with large quantity. Its direction of flow 
is always the same. A faradic current is an induced current 
obtained by use of an induction coil. Such a current pos- 
sesses high potential, small quantity, and its direction of 
flow is to and fro, or alternating. 

What products of phenol are of interest in medicine? 

The phenates or carbolates, e. g. sodium phenate; the 
phenolsulphonates, and trinitrophenol or picric acid. Sali- 
cylic acid and its various products may be synthetically pre- 
pared from phenol. 

Designate the following as chemical or physical changes: 

(a) The souring of milk, (b) Decomposition of sunlight 
by means of prisms. (c) Converting water into steam. 

(d) Dissolving salt in water, (e) Decay of wood. 

(a) Chemical; (b) physical; (c) physical; (d) physical; 

(e) chemical. 

Mention the chief properties of nitrogen. 

Nitrogen: symbol N, atomic weight, 14, (13.93), valence 
III., V., is a colorless, odorless, tasteless gas, a little lighter 
than air, incombustible, a non-supporter of combustion, does 
not support life, is not poisonous. 

What metal is liquid at ordinary temperature? 

Mercury. 

Mention a substance containing albumin, (a) as a liquid, 

(b) as a solid. 

(a) Blood, (ib) Albumin exists naturally only in solu- 
tion, an example of a solid (coagulated) albumin would be 
the white of a hard-boiled egg. 



CHEMISTRY. 273 

What is the chemical cause of spontaneous combustion? 

An active oxidation or other chemical change resulting 
in the development of sufficient heat to cause self-ignition. 

Describe a test for the presence of organic matter in 
water. 

Distill the water until free from ammonia, then add to 
the residue in the retort an alkaline solution of potassium 
permanganate, when if, on again distilling, ammonia ap- 
pears in the distillate, the presence of organic matter would 
'be indicated. 

Give the names and formulas of five acids used in med= 
icine. 

Nitric acid, HN0 3 ; sulphurous acid, H 2 S0 3 ; hydrochloric 
acid, HC1; phosphoric acid, H 3 P0 4 ; acetic acid, HC 2 H 3 2 . 

Mention the elements existing uncombined in nature. 

Hydrogen, oxygen, nitrogen, carbon, sulphur, gold, silver, 
platinum, copper, mercury, and a few other metals. 

What is carbon dioxide? Give its formula, properties, 
uses, and mode of production. 

Carbon dioxide, C0 2 , a 'colorless gas, generally with a faint 
acid odor, soluble in water, a non-supporter of combustion 
and incombustible. It will not support life but is non-pois- 
onous. Carbon dioxide is produced by respiration of ani- 
mals, by the complete burning of carbonaceous matter, by 
heating many metallic carbonates, and by treating carbon- 
ates with acids. It is used in making "soda water" and 
other artificial effervescent drinks; liquified C0 2 is used for 
freezing purposes. It is essential to plant life. 

When and why is a flame produced by combustion? 

When the combustion is sufficiently rapid and active to 
raise the temperature to the ignition point. 

Give the preparation of Fowler's solution, and describe 
the salts contained in it. 

Boil one part arsenious oxide with two parts potassium bi- 

18 



274 CHEMISTRY. 

•carbonate in 94 parts water and add three parts compound 
tincture of lavender. The solution so made contains po- 
tassium metarsenite, an easily soluble compound of arsenic, 
not used in the solid state. 

As 2 3 + 2KHC0 3 = 2KAs0 2 + H 2 + 2C0 2 . 

What is chloroform and how is it made? 

Chloroform, trichlormethane, CHC1 3 . It is a heavy color- 
less liquid, specific gracity of 1.5, with a characteristic etheriai 
odor and a sweet burning taste. Boils at 60-61° C. Pre- 
pared by the action of "bleaching powder" on alcohol, by 
the action of "bleaching powder" on acetone, and by the 
action of an alkali on chloral. 

Describe and illustrate alcoholic fermentation. 

Alcoholic fermentation is the decomposition of a sugar by 
a ferment, with the production of carbon dioxide and alcohol. 
C 6 H 12 6 = 2C0 2 + 2C 2 H 5 OH. 

What is ethyl hydrate? Give its formula and state 
how it is produced. - 

Ethyl hydrate, C 2 H 5 OH, is ordinary alcohol. It is pro- 
duced by the fermentation of glucose. 

Complete the following equations: 

2NaCl + Ag 2 S0 4 => 

Ba0 2 + C0 2 + H 2 = 

2NaCl + Ag 2 S0 4 = 2AgCl + Na 2 S0 4 

Ba0 2 + C0 2 + H 2 = BaC0 3 + H 2 2 

Define matter. 

Matter is that which has weight and occupies space. 
Define and illustrate osmose. 

Osmose is that property by which liquids and certain sub- 
stances in solution pass through porous partitions. Thus, if 
copper sulphate in solution be placed in an unglazed earthen- 
ware vessel, and this be set in a larger vessel containing dis- 
tilled water, the salt will pass through into the water (ex- 



CHEMISTRY. 275 

osmose), while the liquid in the inner vessel will increase in 
quantity (endosmose). 

Give an illustration of decomposition by (a) heat, (b) 
electricity, (c) light. 

(a) Mercuric oxide heated, yields oxygen and mercury. 

(b) Pass a galvanic current through water and the latter 
will be decomposed, hydrogen and oxygen being set free. 

(c) Expose silver chloride to the action of sunlight; it un- 
dergoes decomposition, producing a subchlorid of silver, and 
changing in color from white to grayish-violet. 

What is a compound radical? Give three examples of 
compound radicals, indicating the valence of each. 

A compound radical is a group of atoms capable of play- 
ing the part of an elementary substance and incapable of 
existing in the free state. 

Examples : N0 3 , valence I. ; S0 4 , valence II. ; P0 4 , valence 
III. 

Describe the medicinal uses of oxygen, stating how it is 
brought to the bedside and how it is applied. 

Oxygen gas subjected to pressure is liquefied and stored in 
steel cylinders. The gaseous oxygen from the cylinder 
is conducted into a rubber bag, and from this through a wash 
bottle containing a small quantity of Avater. In the use of 
the oxygen we secure a continuity of flow by allowing the bag 
to fill with the gas and then compressing it. Oxygen is in- 
dicated wherever respiration is embarrassed, in pneumonia, 
pleurisy, asthma, etc. It is also used for its general stimulant 
effect. 

State the composition, mode of preparation and prop= 
erties of sal ammoniac. 

Sal ammoniac, ammonium chloride, NH 4 C1, prepared by 
saturating hydrochloric acid with ammonia. It is a white 
'Crystalline soluble substance with saline taste and neutral 



276 CHEMISTRY. 

properties. It yields ammonia gas when heated with strong; 
bases. Used in medicine as an alterative and as a stimulat- 
ing expectorant. 

What are the distinguishing characteristics of urates 
and of uric acid as deposited in the urine? 

Uric acid is deposited in reddish grains which settle rap- 
idly to the bottom of the vessel and are not dissolved on 
warming. 

Urates form generally a more bulky sediment, pink or white 
in appearance, settling more slowly, and easily dissolved on 
warming. 

Both uric acid and urates respond to the murexid test. 
Under the microscope uric acid appears in yellowish lozenge- 
shaped crystals often in rosette-like groups, while urates are 
generally amorphous or semi-crystalline. 

Mention two substances that are fusible, two substances 
that are volatilized by heat, two substances that are un- 
affected by heat. 

Lead and iron are fusible. Iodine and sulphur volatilize^ 
Carbon and silicon in absence of air, are unaffected by heat. 

Describe iron and its preparations. Why is iron pre- 
scribed in anemic conditions? 

Iron: symbol, Fe, atomic weight, 56 (55.5), valence II., 
IV., (Fe 2 VI), specific gravity 7.84, a gray-white metal, with 
very high melting point, the most tenacious of metals, ductile 
and malleable. 

It oxidizes in air in the presence of moisture and occurs 
in nature chiefly in the form of oxides. 

Preparations frequently used: Ferric chloride, ferric sul- 
phate, ferric acetate, ferric hydroxide, ferrous sulphate, fer- 
rous carbonate, and the metal itself; organic salts of the 
metal, as the peptonate, albuminate, citrate, and tartrate. 

Iron is prescribed in anemic conditions to afford the neces- 
sary element for the making of red blood corpuscles. 



CHEMISTRY. 277 

Give illustrations differentiating combustion, fermenta= 
lion, putrefaction and decay. 

Heat wood in air and it undergoes change into carbon 
dioxide, water, and a residue, called ash. This change, com- 
bustion, is accompanied by a rise in temperature and the 
production of a flame. Wood exposed to air and moisture 
for a lengthy period of time, slowly undergoes destructive 
change, a decay, yielding finally the same products as those 
produced in combustion. 

Fermentation is the decomposition of complex substances 
by organized ferments or by enzymes. As an example we 
have the conversion of glucose into alcohol and carbon dioxide 
by the organized ferment, yeast. 

Putrefaction is the decomposition of nitrogenous organic 
matter by the action of bacteria. 

Explain the use of symbols and formulas. Give and 
translate five examples of each. 

A symbol is used as a representation of one atom of an 
•elementary substance. A formula, an aggregation of sym- 
bols, represents one molecule of a substance. 

Oxygen, ; chlorine, CI ; bromine, Br ; nitrogen, N ; hydro- 
gen, H. 

HN0 3 , nitric acid; H 2 S0 4 , sulphuric acid; PbO, litharge; 
NH 3 , ammonia; NaCl, sodium chloride. 

What is the source of tartaric acid? What is its use in 
medicine? 

It is obtained from argol, the impure cream of tartar de- 
posited during the fermentation of grape juice. It is used 
pure in the seidlitz powder, occasionally as an antiscorbutic, 
etc. Used chiefly in the form of its salts, cream of tartar, 
Rochelle salt, and tartar emetic. 

Explain the principle of the action of yeast. 

Under favoring conditions of proper temperature, presence 
■of moisture, and of air, the yeast plant causes, by its growth, 



278 CHEMISTRY. 

such a rearrangement of the atoms of C, H and in glucose 
as to produce from one molecule of glucose two molecules of 
alcohol and two molecules of carbon dioxide gas. 

How is an excess of urates determined in a sample of 
urine? 

To 200 Cc. of urine add 20 Gc. of strong hydrocloric acid 
and let the mixture stand 48 hours. The urates will he de- 
composed and uric acid deposited. Collect the sediment on 
a previously weighed filter paper, wash, dry, and weigh again. 

What antidote should be employed in a case of strych= 
nine poisoning? 

At once administer an emetic and tannic acid, then give 
potassium bromide in drachm doses ; if convulsions occur use 
inhalation of ether or chloroform. Use rectal injections of 
chloral, etc. 

Define hydride, specific heat, haloid salt. 

A hydride is a binary compound containing hydrogen and 
one other element. 

By specific heat we mean the amount of heat given off or 
absorbed by a definite weight of a substance in undergoing a 
measured change of temperature, as compared with the 
amount of heat given off or absorbed by an equal weight of 
water in undergoing the same change in temperature. 

A haloid salt is one containing a metal or basic radical in 
combination with a member of the halogen or chlorine group. 

In what respect does sterilized milk differ from raw 
milk? 

The sterilizing of milk coagulates the lactalbumin and 
the globulin, and modifies the casein. On acidifying the ster- 
ilized milk all the proteids are precipitated at once in a firm 
curd not easily digested. In sterilizing milk, germs that 
may be present are killed. 



CHEMISTRY. 279 

Complete the following equations and write the name 
of each resulting compound under its formula: 

As 2 3 + 3H 2 S =. 

H 2 S0 4 + NaN0 3 = 

As 2 3 + 3H 2 S = As 2 S 3 + 3H 2 

Arsenic trisulphide. Water. 

H 2 S0 4 + NaN0 3 = NaHS0 4 + HN0 3 

Sodium hydrogen sulphate. Nitric acid. 

Explain the chemistry of a candle flame. 

Candle flame shows three distinct zones : Inner one con- 
sisting of vaporized hydrocarbons gives no illumination and 
scarcely any heat. Middle flame, the illuminating flame, 
consists of solid carbon in fine subdivision rendered in- 
candescent by the heat due to the combination of oxygen 
with hydrocarbon vapors, gives a large amount of heat. 
Third or surrounding zone, darker in color, contains solid 
particles of carbon, as soot, also carbon dioxide and vapor 
of water, as a result of the burning of the hydrocarbon 
vapors, supplies but little heat or light. 

Write the chemical name and formula for laughing gas. 

Nitrous oxide, or nitrogen monoxide, N 2 0. 

What is the chemical change which occurs in the making 
of malt? 

Starch under the action of a ferment is changed to maltose, 
through chemical union with water. 

2C 6 H 10 O 5 + H 2 = C^HjAi- 

Explain how water containing organic impurities may 
become purified by running in a shallow stream or over a 
precipice. 

All parts of the water and its contained impurities are 
brought in contact with atmospheric oxygen; the organic 
matter is oxidized and decomposed. 

What is ammonium? 

Ammonium, NH 4 , is a basic radical forming compounds 



280 CHEMISTRY. 

similar to those of the alkali metals. Its relation to ammonia, 
NH 3 , is shown in the manner of formation of its compounds, 
e. g. ammonium chloride, NH 3 -f- HC1 = NH 4 C1. 

Mention a test of C0 2 , and also its chief properties. 

When passed into clear lime-water it produces a white 
precipitate of calcium carbonate. Carbon dioxide is a gas 
about iy 2 times the weight of air, a non-supporter of com- 
bustion and incombustible, produced by the complete oxi- 
dation of carbon. It is colorless, has a faint acid odor, and 
is soluble in water. 

What elements enter into the composition of all alka= 
loids? 

Carbon, hydrogen, nitrogen, in volatile alkaloids. Carbon, 
hydrogen, nitrogen and oxygen, in fixed alkaloids. 

Explain an experiment to prove that chemical action 
may be induced by light. 

The sun's rays or diffused daylight will bring about chem- 
ical union between hydrogen and chlorine to form hydro- 
chloric acid, this union being accomplished with explosive 
violence. Mix equal volumes of hydrogen and chlorine in a 
glass jar and place in the sunlight. 

What is the technical name of (a) aqua regia, (b) aqua 
fortis, (c) oil of vitriol? 

(a) Nitro-hydro chloric acid; (b) nitric acid; (c) sulphuric 
acid. 

Describe the properties of hydrogen, and mention a test 
to prove that it will not support combustion. 

It is a colorless, tasteless, odorless gas, lightest of the well- 
known elementary gases; burns in air or oxygen; will not 
support combustion nor animal respiration. It is strongly 
electro-positive. A proof that it does not support combustion 
is afforded by plunging a lighted taper into a jar of hydro- 
gen, held mouth downward; the flame of the taper is extin- 



CHEMISTRY. 281 

guished, -although the hydrogen may burn at the mouth of 
the jar. 

Give the composition of aqua ammoniac 

Ammonium hydroxide NH 4 0H, is theoretically composed 
of one molecule of ammonia gas, NH 3 , dissolved in and chemi- 
cally combined with one molecule of water. The aqua am- 
monias of the U. S. P. is an aqueous solution of ammonia 
containing 10 per cent, by weight of the gas. 

What is peroxide of hydrogen? 

Peroxide of hydrogen or hydrogen dioxide, H 2 2 , in its 
purest form, is a syrupy liquid. The usual strength in com- 
merce is a 3 per cent, by weight solution giving off 10 volumes 
of available oxygen. 

Account for the poisonous property of illuminating gas. 

The poisonous action is due to the presence of carbon 
monoxide and in less degree to carbon dioxide, various hydro- 
carbons and sulphur compounds. 

What is the normal reaction of (a) saliva, (b) bile? 
What causes the reaction? 

(a) Alkaline, from the presence of bicarbonates and phos- 
phates of the alkalies and alkaline earths; (b) alkaline, from 
the presence of alkaline carbonates, and the sodium salts 
of organic acids. 

Give formula for (a) mercuric chloride, (b) sodic sul= 
phate, (c) potassium chlorate, (d) cupric nitrate, (e) cal= 
cium carbonate. 

(a) HgCl 2 ; (b) Na 2 S0 4 ; (c) KC10 3 ; (d) Cu(N0 3 ) 2 ; (e) 
CaCO s . 

Define saturation. 

The term saturation, applied to a liquid, means that the 
liquid holds dissolved all of a solid or gaseous body that it is 
capable of dissolving. 



282 CHEMISTRY. 

Discuss the value of sulphur as a germicide. 

Sulphur will act as a germicide only when combined with 
oxygen to form sulphur dioxide. 

In its germicidal action, the sulphur dioxide extracts mois- 
ture to form sulphurous acid and this acts as a deoxidizing 
or reducing agent. 

Practically it must he remembered, that sulphur dioxide 
is a bleaching agent, so that care must be taken to remove 
from the room colored fabrics of value. 

By what forces can (a) a solid be changed into a liquid 
or a gas, (b) a gas be changed into a liquid or a solid? 

(a) By heat or by lessened pressure; (b) by cold or by 
increasing pressure. 

What is the composition of baking powders? How are 
they adulterated? What is their mode of action? 

They all contain sodium bicarbonate mixed with an acid 
salt as potassium bi-tartrate, or a weak acid. 

In the presence of heat and moisture their contained chemi- 
cals react with the evolution of carbon dioxide. 

KHC 4 H 4 6 + NaHC0 3 ==KNaC 4 H 4 6 + H 2 + C0 2 . 

Among adulterants are alum, flour, ichalk and gypsum. 

What is turpentine? 

Turpentine, C 10 H 16 , an essential oil, is a hydrocarbon ob- 
tained from the exudate of pine trees. 

State the properties and uses of H 2 S0 4 . 

Sulphuric acid, H 2 S0 4 , a heavy corrosive liquid, colorless 
when pure but often brown from presence of carbon. It has 
a strong affinity for water, the union of the two being accom- 
panied by the evolution of heat. It is one of the most im- 
portant of all known manufactured substances, being used 
directly or indirectly in a great variety of industries. It is 
an important chemical reagent and forms many salts of im- 
portance medicinally. 



CHEMISTRY. 283 

How does diet affect the elimination of urea? 

A nitrogenous diet tends to increase the elimination of urea. 

A restricted diet, starvation, or a non-nitrogenous diet 
diminishes the elimination of urea. 

Disease accompanied by rapid or long-continued tissue 
changes, as during high fevers, may be accompanied by in- 
creased elimination of urea even in the absence of a nitro- 
genous diet. 

What are bromides, iodides, chlorides? 

Bromides are salts of hydrobromic acid; iodides are salts, 
of hydriodic acid; and chlorides are salts of hydrochloric 
acid. 

Write the formula of (a) sulphurous acid, (b) acetic 
acid, (c) hydrochloric acid, (d) water, (e) cupric sulphate. 

(a) H 2 S0 3 ; (b) HC 2 H 3 2 ; (c) HC1; (d) H 2 0;"(e) CuS0 4 . 

What are mineral waters? 

Mineral waters are such waters as contain too great a quan- 
tity of dissolved mineral salts to warrant their use for ordi- 
nary drinking purposes. 

They possess various medicinal virtues in accordance with 
the particular kind of mineral salts contained. 

Give the composition of water by volume and by weight. 

Water is composed of two volumes of hydrogen and one 
volume of oxygen. 

Water is composed of two parts by weight of hydrogen 
with 16 parts by weight of oxygen. 

Give test for the presence of sulphuric acid in vinegar. 

To vinegar add a few drops of a solution of barium nitrate, 
when, should sulphuric acid be present, there will form a 
white precipitate insoluble in acids. 

How may the presence of arsenic in wall=paper be de- 
tected? 

Use the Reinsch test : The paper, torn into fragments. 



284 CHEMISTRY. 

is placed in a beaker along with hydrochloric acid and water, 
bring to a boil and introduce a strip of clean copper foil. 
If a gray coating form on the copper dry it carefully and 
heat in an ignition tube. If the coating be due to arsenic 
it will be volatilized and will deposit on the cooler portion of 
the tube in crystals of arsenious oxide. 

What chemical changes take place in decaying bodies? 

All the body tissues including the complex albuminoid 
substances are split up, by decomposition, into simple sub- 
stances. Among these products of decomposition, are pep- 
tones, ptomaines, leucin, tyrosin, amines, acids, ammonia, am- 
monium sulphide, hydrogen sulphide, etc. Finally we have 
produced, simply, water, carbon dioxide, ammonia, hydrogen 
sulphide, and mineral residues. 

What is the antidote for poisoning from hydrocyanic 
acid? 

Hydrogen dioxide. There is also used a solution of mixed 
ferrous and ferric sulphates with sodium or potassium hy- 
droxide or carbonate added. Use ammonia by inhalation, 
artificial respiration, faradism to the heart. 

What antidotes should be used in phosphorus poison= 
ing? Why? 

Copper sulphate in solution acts antidotally to phos- 
phorus through producing an insoluble copper phosphide. 

Old French ozonized oil of turpentine acts as an antidote 
to phosphorus, by oxidizing it to a comparatively harmless 
form. 

What double salts of tartaric acid are used in medicine? 

Double tartrate of potassium and sodium, or Rochelle salt. 

Double tartrate of potassium and antimony (SbO), or 
tartar emetic. 

Double tartrate of potassium and hydrogen, or cream of 
tartar. 



CHEMISTRY. 285 

Mention five common vegetable poisons, and state the 
antidote for one of them. 

Opium, belladonna, aconite, digitalis, nux vomica. 
Antidotes to opium are permanganate of potassium, atro- 
pine, caffeine. 

Describe the preparation of hydrogen dioxide, writing 
the reaction. Give uses of hydrogen dioxide. 

Mix barium dioxide with water, pass C0 2 gas through 
the mixture, filter, concentrate the filtrate by evaporation in 
vacuum over strong sulphuric acid. Ba0 2 + H 2 + C0 2 = 
BaC0 3 + H 2 2 . Made also by the action of an acid on barium 
dioxide Ba0 2 + H 2 S0 4 = BaS0 4 + H 2 2 . Uses : For bleach- 
ing, disinfection and for destroying pus; it is a strong oxid- 
izing agent. 

Complete the following equations: 

CuS0 4 + 2KOH = 

NaHC0 8 + HCl = 

CuS0 4 + 2KOH = Cu(OH)o + K 2 S0 4 . 

NaHC0 3 + HC1 = NaCl + H 2 + C0 2 . 

Describe an electric battery, and explain the operation 
of the chemicals used. 

An electric battery is composed of several cells. An elec- 
tric cell may be made as follows : Two plates of dissimilar 
substances are immersed in an acid or other fluid which acts 
upon one of the substances more than upon the other. If 
these two plates are joined outside of the cell by a wire a 
current of electricity will flow, from one plate to the other 
through the liquid, returning by the connecting wire. If the 
plates are made of carbon and zinc, and the solution used is 
dilute sulphuric acid, the zinc plate will gradually dissolve, 
zinc sulphate will accumulate in the solution, and hydrogen 
gas will be given off at the carbon plate. The current is 
said to flow from the zinc to the carbon through the liquid, 
and from the carbon to the zinc through the connecting wire.. 



286 CHEMISTRY. 

Give the sources and uses of ammonia in medicine and 
in the arts. 

Ammonia is obtained from the ammoniaeal liquor produced 
in the manufacture of illuminating gas from coal. The gas 
may he obtained in a pure state by heating a salt of ammon- 
ium with a strong base. 

Ammonia is used in medicine as a cardiac and a general, 
quickly- acting, stimulant. In the arts it is used as a volatile 
base, as a cleansing, detergent substance, as an ant-acid. 

Show by equation how nitric acid is formed by the action 
of sulphuric acid on potassium nitrate. How is nitric acid 
distinguished from the other mineral acids? 

2KN0 3 + H 2 S0 4 = 2HN0 8 + K 2 S0 4 . 
Nitric acid in contact with metallic copper yields a greenish- 
blue liquid, and gives rise to orange-red fumes of N 2 4 , this 
action not being brought about by any other of the mineral 
acids. 

Indicate by chemical sign and symbols the reactions 
that occur when (a) a phosphorus match is lighted in the 
air, (b) sodium is placed on the surface of the water, (c) 
hydrochloric acid is poured on marble, (d) two portions 
of seidlitz powder are mixed in water. 

(a) P 4 + air(50 2 ) = 2P 2 O 5 - 

(b) Na 2 + H 2 = Na 2 + H 2 ; then Na 2 + H 2 = 2NaOH. 

(c) 2HC1 + CaC0 3 = CaCL + H 2 + C0 2 . 

(d) KNaC 4 H 4 6 + NaHCO 3 + H 2 C 4 H 4 6 == 

KNaC 4 H 4 6 + NaHC 4 H 4 6 + H 2 + C0 2 . 

Describe the chemistry of alcohols and ethers. 

An alcohol is a compound of a hydrocarbon radical with 
hydrOxyl. 

An ether is an oxide of a hydrocarbon radical. 

What treatment is indicated in a case of poisoning by 
mercuric chloride? 

Administer albumin, of eggs, milk, flour, etc., and then 



CHEMISTRY. 287 

use stomach, pump, or emetic, to at once remove the newly 
formed albuminate of mercury. Repeat this process several 
times. 

Explain the constitution of the fats and the process of 
saponification. 

A fat is a chemical union of glycerin with a fat acid. 

If a base, such as caustic potash, be boiled with a fat, the 
glycerin is separated from the acid, and the latter combines 
with the base to form a salt known as a soap. 

Complete the following equations: 

AgN0 3 + NaCl = 
Si0 2 + HF = 

AgN0 3 + Nad = AgCl + NaNO s . 
Si0 2 + 4HF = SiF 4 + 2H 2 0. 

Find the weight and the volume of hydrogen contained 
in 17 grams of NH 3 . 

The atomic weight of nitrogen is 14, of hydrogen 1, the 
molecular weight of NH 3 is, therefore, 17, and in 17 grams 
of NH 3 there must be 3 grams of hydrogen. One litre of 
hydrogen weighs 0.0899 gram ; three grams of hydrogen, then, 
must measure 33.48 litres (3 -=-0.0899). 

What is sulphuretted hydrogen? Give its formula, 
property and uses. 

Sulphuretted hydrogen or hydrogen sulphide, H 2 S is a 
colorless gas, slightly heavier than air, of offensive odor and 
poisonous action. It is soluble in water, and burns in air 
with, a blue name, forming sulphur dioxide and water. It is 
used as a group reagent, precipitating a number of metals 
in the form of insoluble sulphides. 

Name and give the formulas of three important salts of 
potassium used in medicine. 

Potassium acetate, KC 2 H 3 2 . 
Potassium nitrate, KN0 3 . 
Potassium chlorate, KC10 3 . 



288 CHEMISTRY. 

What is methylic alcohol? What are its properties and 
uses? 

Methylic or wood alcohol, CH 3 OH, is obtained as a product 
of the destructive distillation of wood. It is a light, colorless 
liquid, miscible with water, inflammable, burning with a non- 
luminous flame. 

It has a large use in the arts as a solvent for resinous and 
gum-like substances, as in the making of varnishes; and is 
used as a fuel. 

Defend the statement, " Matter is indestructible." 

That matter is indestructible may be illustrated by the 
burning of a candle, where although the candle loses in weight 
from the consumption of its wax, yet if care be taken to save 
and weigh the results of the combustion it will be found that 
nothing has been lost, that the burned substance has merely 
assumed a different form. 

Explain and illustrate the law of chemical combination 
by volume. 

Law of G-ay-Lussac: When two or more gases combine 
chemically to form a gaseous compound the volumes of the 
individual constituents bear a simple relation to the volume 
of the product. Thus one volume of hydrogen combines 
with one volume of chlorine to form two volumes of hydro- 
chloric acid vapor. Again, three volumes of hydrogen com- 
bine with one volume of nitrogen to form two volumes of 
ammonia. 

Give the history, occurrence in nature and preparation 
of oxygen. 

Attention was first called to the existence of oxygen by Dr. 
John.Mayow, of England, in 1664. Oxygen was discovered by 
Dr. Joseph Priestley, of Birmingham, England, on August 
1st, 1774. It was given the name oxygen, "acid-producer," 
by Lavoisier, the French chemist, because it was believed to 
be an essential constituent of all acids. 

It is found free in air and dissolved in water. It is found 



CHEMISTRY. 289 

in combination in water and in most animal, vegetable, and 
mineral compounds. It may be prepared by beating a mix- 
ture of manganese dioxide and potassium cblorate. 

Give reasons from a chemical standpoint for the use of 
gold and silver for coin. 

They do not oxidize in air or water ; when properly alloyed 
tbey are durable; their degree of purity may be readily de- 
termined by reagents; they do not communicate an odor or 
a poisonous effect when handled and their intrinsic value 
is fairly constant. 

Name three metals of the alkaline earths, giving a com= 
pound of each with its formula. 

Barium ; barium chloride, BaCl 2 . 

Strontium; strontium nitrate, Sr(N0 3 ) 2 . 

Calcium; calcium carbonate, CaC0 3 . 

What are the general characteristics of the metals of 
the iron group? 

When at a red heat they decompose water; their oxides, 
hydroxides, phosphates and carbonates are insoluble in water. 
They have relatively high fusing points, and considerable 
tenacity, malleability and ductility. They are all precipi- 
tated when in alkaline solution, by hydrogen sulphide. 

What is coal=oil, and what are some of its principal 
products used in the practice of medicine? 

Coal oil, or petroleum, is a brown-colored oil found in 
nature and probably produced from decomposition of or- 
ganic matter. It is a mixture of liquid paraffin hydro- 
carbons, containing the gaseous and solid hydrocarbons in 
solution. Some of the principal products used in medicine 
are benzin or benzinum, petrolatum liquidum or liquid vase- 
line, petrolatum or vaseline, and paraffinum or paraffin wax. 

Complete the following equation and write the name of 
the resulting compounds: 

C 2 HC1 3 + KOH = 

C 2 HCl 3 0+KOH = KCOOH + CHC1 3 

Potassium formate. Chloroform. 

19 



290 CHEMISTRY. 

Give the general properties of alkaloids. 

The alkaloids may be described as organic nitrogenous sub- 
stances, basic in character, capable of combining directly with 
acids to form salts. They are ■commonly divided into two 
groups: (1) Liquid or Volatile alkaloids, containing carbon, 
hydrogen and nitrogen. (2) Fixed or non- volatile alkaloids 
containing, carbon, hydrogen, nitrogen and oxygen. They 
may also be classified according to origin as vegetable, ani- 
mal, or synthetic. The volatile alkaloids are volatile liquids 
colorless when pure and freshly prepared, but turning brown 
on exposure to the air. Examples, nicotine, ©online, spar- 
teine. The non- volatile alkaloids are crystalline solids. Ex- 
amples, morphine, aconitine, quinine. Most alkaloids are 
soluble or very slightly soluble in water, more soluble in al- 
cohol and in chloroform while the salts of the alkaloids are 
generally soluble in water and alcohol and less soluble in 
chloroform. 

What is the percentage composition of NaN0 3 ? 

Atomic weight of Na is 23; of N, 14; of 0, 16; of 3 , 48. 
The molecular weight then, of NaN0 3 is 85. 

85 :100 : :23 :X = sodium, 27. per cent. 
85 :100 : :14 :X = nitrogen, 16.4 " 
85 :100::48:X = oxygen, 56.6 " 



100.0 



Why is capillary attraction so called? Mention some 
familiar examples. 

Because this force is best observed in liquids enclosed in 
minute tubes, hair-like in size; (Capillus, hair.) 

The rise of oil in a lamp wick. The flow of sap through 
vegetable fibre. The absorption of a liquid by blotting-paper. 

Define sterilization. 

Sterilization is the process of removing that upon which 
germs depend for food and existence. 



CHEMISTRY. 291 

How does permanganate of potassium act as a disin= 
fectant? 

In contact with, organic matter it undergoes decomposition, 
liberating its oxygen in a nascent form. 

Upon what theory are eggs given in cases of poisoning 
by corrosive mercury? 

That the albumin of the egg will form an insoluble album- 
inate of mercury. 

Give the boi!ing=point (Fahrenheit) of water, alcohol, 
of ether, of mercury. 

Water boils at 212° ; alcohol at 173° ; ether at 96° ; mer- 
cury at 675°. 

Give the names and formulas of four iodides commonly 
used in medicine. 

Mercuric iodide, or the red iodide of mercury, Hgl 2 ; potas- 
sium iodide, KI; sodium iodide, Nal; strontium iodide, Srl 2 . 

Give the formula for carbolic acid. How is it obtained, 
and what are its properties and uses? 

Carbolic acid, phenol, C 6 H 5 OH, produced in the destruc- 
tive distillation of coal, is obtained from coal tar. When 
pure is a crystalline solid with a characteristic odor, pun- 
gent and caustic taste, forming a Avhite eschar on the skin. 
The crystals require an addition of but five per cent, of 
water to liquefy them ; if more water be added a turbid mix- 
ture results, which again becomes clear when 20 parts of 
water have been added. Carbolic acid is soluble in 20 parts 
of water; easily soluble in alcohol, glycerin and oils. It is 
used as an antiseptic, a disinfectant and a caustic. It has 
slight local anesthetic properties. 

Give the comparative constituent of cows' milk and 
human milk as relating to water, fat, sugar, albuminoids. 

Cow 's milk, according to Frankland, will show on the aver- 
age, water 87.5 p. c, fat, 3.8 p. c, sugar, 3.8 p. c. and al- 
buminoids (proteids), 4.2 p. c. 



292 CHEMISTRY. 

Woman's milk will show water, 88.6 p. c, fat, 3.5 p. c, 
sugar, 5.0 p. c. and albuminoid (proteids) 2.7 p. c. 

Human milk contains, then, rather less proteid, more sugar, 
about the same amount of fat, and rather less water, than 
cow's milk. 

How are the compounds containing two, three, or four 
elements distinguished by name? Define hydroxide. 

Compounds composed of 'two elements are called binary 
compounds, and their names, if they are salts, end in "ide." 

Compounds containing three elements are ternary com- 
pounds and, if acids, their names terminate in "ic," or in 
"ousv;" while if salts their names end in "ate," or "ite." 

Compounds made up of four elements are called quater- 
nary compounds. 

A hydroxide is a compound of the radical, hydroxyl OH, 
with a metal or basic radical. 

Define anhydrous, deliquescent, electrolysis, decantation. 

An anhydrous substance is one from which water has been 
removed, as anhydrous sulphate of copper. 

A deliquescent substance is one which will absorb moisture 
on exposure to air. 

Electrolysis is decomposition of a fluid into its constituents 
by the action of an electric current. 

Decantation refers to the act of pouring off a supernatant 
liquid from a precipitate or sediment. 

Give the reaction of tannin with (a) preparations of 
iron, (b) gelatin. 

(a) A purplish-black precipitate of a tannate of iron is 
formed, (b) Forms immediately a brownish precipitate. 

What relation does the amount of solid matter in urine 
bear to the specific gravity of urine? 

The total solids in 1000 Oc. of urine are approximately 
equal to 2.33 (Hasers coefficient) times the last two figures 
of the specific gravity. 



CHEMISTRY. 293 

Give source and characteristics of citric acid. 

Citric acid, H 3 C 6 H 5 7 , H 2 0, is obtained from lemons and 
limes. Occurs as colorless, rhombic crystals, odorless, acid 
taste, efflorescing in warm dry air and deliquescing in moist 
air. Soluble in water and alcohol, antiseptic, antiscorbutic, 
and refrigerant. 

Give the formula, synonyms and properties of (a) mer= 
curous iodide, (b) mercuric iodide. 

Mercurous iodide, Hg 2 I 2 or 2HgI, known also as proto-iodide 
of mercury, and yellow mercurous iodide, is a yellow, odorless, 
tasteless powder, almost insoluble in water, insoluble in al- 
cohol, easily undergoing decomposition into mercuric iodide 
and mercury. 

Mercuric iodide, bin-iodide of mercury, or red mercuric 
iodide, Hgl 2 , is a scarlet-red, odorless, tasteless powder, al- 
most insoluble in water, slightly soluble in alcohol, becomes 
yellow on heating, regaining red color when cooled. It is 
poisonous and resembles mercuric chloride in therapeutic 
activity. 

Give the formula, preparation and properties of nitrate 
of silver. Mention a test for nitrate of silver. 

AgN0 3 ; formed by dissolving silver in nitric acid, evapor- 
ating the excess of acid, dissolving the residue in water and 
evaporating to crystallization. It occurs in colorless rhombic 
crystals, odorless but with caustic, metallic taste. Easily 
soluble in water, less soluble in alcohol. It is a self-limiting 
caustic, and is employed internally, as an astringent and 
alterative. Test: A soluble chloride added to silver nitrate 
solution precipitates curdy white silver chloride, soluble in 
ammonium hydroxide, insoluble in nitric acid. Evaporated 
with phenolsulphuric acid a pink coloration, characteristic of 
nitrates, is obtained. 

Mention the properties of (a) hydriodic acid, (b) hydro- 
bromic acid. 

(a) Hydriodic acid, HI, is a fuming, colorless gas, strongly 



294 CHEMISTRY. 

acid, freely soluble in water to form a colorless solution 
turning brown from decomposition and separation of free 
iodine. Hydriodic acid possesses, in less marked degree the 
general properties of hydrochloric acid: its binary salts are 
used medicinally. 

(b) Hydrobromic. acid, HBr, is a colorless gas of acid na- 
ture, soluble in water forming a clear colorless liquid having 
properties closely resembling those of hydrochloric acid — 
its binary salts are used in medicine. 

Give a test for the detection of alum in baking-powder. 

Dissolve in 25 Cc. water and add 5 Cc. of a 5% solution 
of ammonium carbonate. If alum is present, a violet or la- 
vender color is produced. 

Give the chemical changes occurring when potassium is 
placed on water. 

Two atoms of potassium displace two atoms of hydrogen 
from a water molecule to form K 2 and this combines with 
a second water molecule to form two molecules of potassium 
hydroxide. The liberated hydrogen takes fire from the heat 
of the chemical action. 

H 2 + K 2 = K 2 + H 2 . 

K 2 + H 2 = 2KOH. 



Define photography. 

It is the art of obtaining in permanent form the images of 
the camera obscura, by causing light to produce chemical 
changes on sensitive substances. 

Write the graphic formula of (a) sulphuric acid, (b) 
nitric acid, (c) calcium hydrate. 

(^ HO g^-0 
W HO >b ^O 

(b) HO-N^° 

(c) HO — Ca — OH 



CHEMISTRY. 295 

Describe the relations of oxygen to combustion and to 
life. 

Oxygen is the great, universal supporter of combustion, 
entering into chemical union with all well-known elements 
(except fluorine) often with sufficient energy to produce heat 
and light (active combustion). 

Since life is maintained only through a constant oxidation 
of existing tissues, (a form of slow combustion) and the 
replacement of these oxidized and decomposed structures by 
new materials, oxygen is essential to life. 

What mineral acids are incompatible with mercurous 
chloride? Give synonyms of mercurous chloride. 

Mercurous chloride, Hg 2 Cl 2 or 2HgCl, known also as 
calomel, mild mercurous chloride, and proto-chloride of 
mercury. 

This substance is incompatible with sulphurous acid, hydro- 
chloric acid, and, in general, with all strong mineral acids. 

Describe the appearance of urine containing bile. 

Such urine varies in color from greenish-brown to a brown- 
ish-black (porter-colored), and produces on shaking, a per- 
sistent froth, yellow in color. 

Define decomposition, putrefaction. 

Decomposition refers to the breaking up of a complex or 
compound substance into simpler substances. 

Putrefaction is the decomposition of a nitrogenous or- 
ganic substance into simpler bodies by bacterial action. 

Give the general definition of an ether. 

An ether is an oxide of a hydrocarbon radical. 

Give a test for the detection of hydrocyanic acid in 
solution. 

Silver nitrate produces a curdy white precipitate of silver 
cyanide, soluble in ammonium hydroxide, and in strong boil- 
ing nitric acid. 



296 CHEMISTRY. 

Complete the following equations: 

CH 3 Cl + HCl + Zn = 

2FeCl 3 + H 2 S = 

CH3CI + HC1 + Zn = CH 4 + ZnCl 2 . 

2FeCl 3 + H 2 S == 2FeCl 2 + 2HC1 + S. 

Give the symbol, valence and a principal compound of 
each of ten elements. 

Hydrogen, symbol H, valence I, water, H 2 0. 

Oxygen, symbol 0, valence II, nitrous oxide, N 2 0. 

Nitrogen, symbol N, valence I, III, V, ammonia, NH 3 . 

Iodine, symbol I, valence I, potassium iodide, KI. 

Sulphur, symbol S, valence II, IV, VI, hydrogen sul- 
phide, H 2 S. 

Bromine, symbol Br, valence I, sodium bromide, NaBr. 

Iron, symbol Fe, valence II, IV (Fe 2 VI) ferrous sul- 
phate, FeS0 4 . 

Calcium, symbol Ca, valence II, calcium hydroxide, 
Ca(OH) 2 . 

Magnesium, symbol Mg, valence II, magnesium carbon- 
ate, MgC0 3 . 

Silicon, symbol Si, valence IV, silicon oxide, Si0 2 . 

State the normal reaction of synovial fluid. 

Alkaline. 

Describe the microscopic appearance of (a) uric acid, 
(b) triple phosphates. 

(a) Yellow to orange-red in color, losenge-shaped, rhombic 
prisms or modified forms, often grouped in star-shaped, or 
fan-shaped clusters, sharply pointed at angles. 

(b) "White, triangular prisms, coffin-shaped; or in star- 
shaped, feathery crystals. 

Give a typical example and state the principal ingre= 
dients of each of the following mineral waters: Saline 
cathartic, alkaline, sulphurous. 

Saline cathartic water may be represented by Carlsbad 



CHEMISTRY. 297 



mineral water containing sulphates of sodium and potassium, 
and carbonates of sodium, calcium and iron. 

An alkaline mineral water as Buffalo lithia water contains 
carbonates of lithium, calcium, sodium and potassium, and 
usually an excess of C0 2 although not in sufficient amount to 
produce effervescence. 

A sulphurous water, as that of red sulphur spring of Vir- 
ginia, usually contains hydrogen sulphide, or an alkaline 
poly-sulphide. 

Give the characteristics of (a) nephritic urine, (b) cys= 
titic urine. 

In acute nephritic conditions the urine may be diminished 
in amount with normal or increased specific gravity and con- 
siderable albumin. In chronic nephritis the urine may be 
normal or increased in amount, the specific gravity low and 
the albumin variable. Nephritic urine always shows casts of 
the uriniferous tubules. 

In acute cystitis the urine shows pus, mucus, and epithe- 
lium and the reaction may be neutral or acid. In ohronic 
cystitis the urine contains pus, mucus, epithelium and separ- 
ated "triple phosphates" and the reaction is ammoniacal. 

Express the following in apothecaries' weight and 
measure: 

Ammonii carb 5 grams 

Syr. aurantii 60 c. c. 

Aquae destil. ad 120 c. c. 

Ammonia carb grs. lxxvii 

Syr. aurantii ^ ij 

Aquse destil. ad ^ iv 

Complete the following equations: 

C 2 H 5 N0 3 + KOH == 
CaC0 3 + 2HC1 = 

C 2 H 5 N0 3 + KOH = C 2 H 5 OH + KN0 3 . 

CaC0 3 + 2HC1 = OaCl 2 + H 2 + C0 2 . 



298 CHEMISTRY. 

Give the general characteristics of bismuth. 

Bismuth, Bi, atomic weight, 207 (206.9), valence III, 
specific gravity 9.9, melts 512° F., is a 'brittle, white metalloid 
with reddish tint, crystalline, occurs native and as the sul- 
phide, frequently associated with arsenic. 

Define and illustrate monatomic element, neutral salt. 

A monatomic element, like mercury, is one whose molecule 
contains but one atom, and whose molecular weight corres- 
ponds with the atomic weight. 

A neutral or normal salt is one formed from an acid by 
substituting a metal or basic radical for all of the replaceable 
hydrogen. Example : Sodium sulphate, Na 2 S0 4 , formed from 
sulphuric acid, H 2 S0 4 . 

Indicate the sources of the following acids: Lactic, 
butyric. 

Lactic acid is developed from lactose in souring milk. 
It is produced on the large scale by the lactic fermentation 
of cane sugar or glucose. 

Butyric acid occurs in rancid butter, and cheese. It is 
prepared by fermenting a mixture of sugar and old cheese. 

Mention a diatomic element and give its chemical prop= 
erties. 

Oxygen, symbol 0, atomic weight 16, valence II., electro- 
negative, supporter of combustion, combines with all well- 
known elements except fluorine. 

Give an explanation of the formation of ammonia in the 
urine. 

Under the influence of the micrococcus ureae taken up from 
the atmosphere, the urea is changed into ammonium carbon- 
ate. 

CO(NH 2 ) 2 + 2H 2 0=(NH 4 ) 2 C0 3 . 

Complete the following equations: 

2FeCl 2 + 2HC1 + = 
2Na 2 HP0 4 + 3CaCl 2 = 



CHEMISTRY. 299 

2FeCl 2 + 2HC1 + = Fe 2 Cl 6 + H 2 0. 

2Na 2 HP0 4 + 3CaCl 2 = Ca a (POJ 2 + 4NaCl + 2HC1. 

Give the formula and properties of (a) chlorate of po= 
tassium, (b) ammonia gas, (c) tartaric acid. 

(a) Chlorate of potassium, KC10 3 , white crystalline solid, 
permanent in air, soluble in 16.7 parts of cold water and 1.7 
parts boiling water. A strong oxidizing agent, decomposible 
by heat into oxygen and potassium chloride, forms explosive 
mixtures when in contact with strong acids or organic matter. 
It is a mild astringent and antiseptic. 

(b) Ammonia gas, NH 3 , is a strongly basic, diffusible, irre- 
spirable gas, extremely light, and very soluble in water; it is 
colorless, alkaline and caustic in taste and effect. 

(c) Tartaric acid, H 2 C 4 H 4 6 , found in vegetables and 
fruits : in its pure form occurs as colorless, transparent prisms, 
strongly acid and readily soluble in water and in alcohol: 
crystals melt at 135° C. It forms salts, of which Rochelle 
salt, KNaC 4 H 4 6 , cream of tartar, KHC 4 H 4 6 , and tartar 
emetic, KSbOC 4 H 4 6 are medicinally useful. 

How is anilin obtained? State how anilin dyes are 
manufactured from anilin. 

Anilin, C 6 H 5 NH 2 is obtained by the action of nascent hy- 
drogen on nitrobenzene. 

Anilin dyes are made by oxidizing mixtures of anilin and 
toluidin with nitric or chromic acids or other oxidizing agents. 

Mention two reactions by which hydrocyanic acid is 
formed. Give the properties of hydrocyanic acid. 

Add hydrochloric acid to potassium cyanide and obtain 
potassium chloride and hydrocyanic acid. Add hydrochloric 
acid to silver cyanide and obtain silver chloride and hydro- 
cyanic acid. 

Hydrocyanic acid is a volatile colorless liquid, with odor 
of bitter almonds. It is extremely poisonous and is em- 
ployed in medicine in a 2% water solution. 



300 CHEMISTRY. 

Give the symptoms and diagnostic features of oxalic 
acid poisoning. With what commonly used salt is oxalic 
acid likely to be confused? 

Symptoms: a hot, burning, sour taste, burning sensation 
extending to stomach, great burning pain in stomach and ab- 
domen, prostration, slight stupor, convulsions, pulse small 
and irregular, numbness of extremities, irregular, spasmodic 
breathing, death. It acts as an irritant and as a heart de- 
pressant. 

Oxalic acid has been frequently confused with magnesium 
sulphate. 

What are aldehydes? Mention the properties and prin= 
cipal derivatives of aldehydes. 

Aldehydes are substances formed by oxidizing (taking two 
hydrogen atoms from) primary alcohols. 

Aldehydes combine directly with ammonia, hydrocyanic 
acid, alkaline sulphites, etc. They are strong reducing agents, 
their oxidation produces fatty acids, their reduction gives 
rise to alcohols. 

Formaldehyde and paraldehyde and, a derivative, trichlor- 
aldehyde or chloral, are all used in medicine. Derived from 
chloral are many addition and decomposition products. 

How are soaps made? What constitutes (a) hard soap, 
(b) soft soap, (c) castile soap? 

By heating a fat, with a strong alkali, (a) Hard soap is 
the sodium salt of a fat acid, (b) Soft soap is the potassium 
salt of a fat acid, (c) Castile soap is a mixture of oleate, 
palmitate and stearate of sodium obtained by saponifying 
olive oil. 

Complete the following equation: 

K 2 Cr 2 7 + 4H 2 S0 4 = 
K 2 Cr 2 7 + 4H 2 S0 4 = Cr 2 (SOJ 8 + K 2 S0 4 + 4H 2 + 8 . 

What is an ion? Give an example of ionization. 

"When acids, bases and salts are dissolved in water they dis- 



CHEMISTRY. 301 

sociate, the molecules break apart. Each particle carries a 
charge of electricity, and is called an ion. Hydrochloric acid 
dissolved in water dissociates into positive ions of hydrogen 
(cations), 'and negative ions of chlorine (anions). 

What simple tests should be employed to determine 
whether or not a suspected water contains albuminoid 
matters sufficient to make its use unhealthful? 

Add to the water a drop or two of dilute sulphuric acid 
and enough potassium permanganate to give a faint pink 
color, cover the vessel with a glass plate and if the pink color 
still persists after the lapse of fifteen minutes the water is 
not greatly impure from organic matter. 

Shake a stoppered flask half full of the suspected water ; 
if no odor is discernible, warm flask and contents for fifteen 
minutes at a temperature not higher than 110° F. and after 
again shaking vigorously should there still be no odor the 
water is probably free of any material quantity of dissolved 
organic matter. 

Mention the principal uses of the following elements 
and their compounds: (a) Fluorine, (b) chromium, (c) sili= 
con, (d) selenium. 

(a) Hydrofluoric acid is used as a solvent for glass ; calcium 
fluoride and the double fluoride of sodium and aluminum 
are employed as fluxes. 

(b) Chromium is used in steel-making; lead chromate and 
barium chromate are used as pigments ; potassium and sodium 
dichromate are important reagents; the oxides are oxidizing 
agents and glass pigments. The oxide Cr0 3 is a powerful 
caustic. 

(c) Silicon in the form of its oxide Si0 2 is used in making 
glass and glass-like substances; hydrofluosilicic acid is a 
chemical reagent; Si0 2 is also used for polishing, filtration, etc. 

(d) Selenium is used, from its non-conducting property, in 
certain electrical appliances; selenic acid, H 2 Se0 4 is used as. 
a solvent for gold. 



302 CHEMISTRY. 

State the atomic weight, valence and uses of sulphur. 

Sulphur, atomic weight 32 (31.83), valence II, IV, VI. 

Is used in making gun powder, matches, as a medicine, is 
incorporated into rubber, is burned to form S0 2 and in this 
combination used for disinfection, bleaching and in making 
sulphuric acid. 

Complete the following equations: 

BaCl 2 + Na 2 S0 4 = 

3P + 5HN0 3 + 2H 2 = 

BaCL + Na 2 S0 4 = BaS0 4 + 2NaCl. 

3P + 5HN0 3 + 2H 2 = 3H 3 P0 4 + 5NO. 

Differentiate arsenic from antimony. 

In Marsh's test on burning the evolved gas both arsenic 
and antimony produce brown-black stains on a piece of cold 
porcelain held in the flame, but the stain due to arsenic is 
freely soluble in chlorinated lime solution while the anti- 
monial stain is almost insoluble in this reagent. If anseni- 
cal and antimonial substances be strongly heated in air, 
arsenic forms octahedral crystals of As 2 3 which dissolving 
in water produce green and yellow precipitates respectively 
with cupric ammonium sulphate and silver ammonium ni- 
trate; while antimony, oxidizing, gives needle-like crystals 
or an amorphous deposit, soluble in water but not precipitated 
by the reagents named. 

Give two chemical tests for blood. 

Add a drop of suspected liquid to a freshly-made tincture 
of guaiacum, in a test-tube, then on the surface of this liquid 
float an etherial solution of hydrogen dioxide. If the sus- 
spected liquid contains blood, a blue color band forms at the 
junction of the two liquids. 

To a drop of blood on a glass slide add a drop or so of 
glacial acetic acid and a small crystal of sodium chloride. 
Heat slowly to boiling, then cool and examine under the mi- 
croscope for crystals of hematin hydrochloride. 



CHEMISTRY. 303 

Describe the tests for acetone, and for diacetic acid in 
the urine. 

For acetone add to the urine sufficient sodium hydroxide 
to give a decided alkaline reaction and then add a few drops 
of an aqueous solution of sodium nitroprusside. The mix- 
ture assumes a ruby-red color. Acidify with glacial acetic 
acid — a purple-red color indicates the presence of acetone. 

Test for diacetic acid: To a freshly-passed specimen of 
urine add a few drops of a ferric chloride solution ; if a pre- 
cipitate forms, filter, and to the nitrate add a few more drops 
of the reagent. If diacetic acid be present there is produced 
a dark red color which fades on boiling. 

Describe a test for excess of hydrochloric acid in the 
gastric contents. 

To 100 co. of filtered gastric contents add a few drops of 
tropaeolin indicator solution, and then titrate with JL alkali 
solution until the magenta color of the solution is destroyed. 
If more than 55 c.c. of the alkali solution are required to neu- 
tralize then the acid is in excess. 

Define albumose; give a test for detection. 

Albumoses are transition compounds formed in the conver- 
sion of albumin into peptone. Albumose is precipitated by 
nitric acid in the cold, dissolves on heating, and is again 
precipitated on cooling. 

Define bilirubin; describe its properties; give test for 
its presence. 

Bilirubin, the principal bile pigment, C 16 H 1S N 2 3 , is a 
reddish-yellow substance, derived from hematin, slightly sol- 
uble in water, more soluble in hot chloroform. 

A drop of the fluid is spread in a thin film on a porcelain 
plate and a drop of yellow nitric acid added. In the pres- 
ence of bile pigment the drop of acid is surrounded by 
colored rings — green, blue, and reddish-yellow. 



304 CHEMISTRY. 

What substances in the urine, other than glucose, may 
produce the reaction of the Fehling's test. 

Glucuronic acid gives the same reaction as does glucose. 
Uric acid, creatinine, pyrocatechin, lactose, pentose, chloro- 
form, etc., may produce partial reactions. 

Describe a chemical test that would suggest the pres= 
ence or absence of gastric carcinoma. 

A marked diminution in or absence of free hydrochloric 
acid in the gastric contents as shown by titration with a yV 
alkali solution. Normally about 55 Cc. of y-g- alkali are re- 
quired to neutralize 100 Cc. of gastric juice. 

Give chemical tests for the various forms of urinary 
calculi. 

A calculus which on heating to redness burns entirely away 
may be of uric acid, urate of ammonium, xanthine, cystin, 
or fibrin. Test a portion of the powder with boiling water; 
urates dissolve, uric acid remains undissolved. Apply the 
murexid test — evaporate with nitric acid and touch the re- 
sidue with a drop of ammonia water. A purple-red color in- 
dicates uric acid or urates. 

If the calculus fuses when heated, giving off water vapor 
and ammonia, it is a "fusible calculus" and consists of a. 
mixture of calcium, magnesium, and ammonium phosphates. 

If the calculus leaves a residue when heated and gives a 
murexid test it consists of sodium urate. If it dissolves in 
acetic acid and a precipitate is formed on adding ammonia 
water it is a phosphate of calcium or magnesium. If it is 
insoluble in acetic acid but soluble in hydrochloric acid, it is 
calcium oxalate. If on adding an acid an effervescence is 
produced a carbonate is present. 

Detail a test for the detection of indoxyl=potassium sul= 
phate (indican). 

To 5 Cc. concentrated fuming hydrochloric acid add 20 
drops of urine, and warm, but do not boil, the mixture. With 



CHEMISTRY. 305 

normal urine the resulting color will be yellow or a very 
pale violet, while with increased indican a darker violet or 
blue will be obtained. If the hydrochloric acid is not suffi- 
ciently concentrated add 1 drop of nitric acid before adding 
the urine. 
20 



PATHOLOGY AND BACTERIOLOGY. 



Describe the protective agencies by which the body 
guards itself against the entrance and harmful effects of 
pathogenic bacteria. 

Phagocytosis, the ingestion and possible destruction of 
"bacteria by certain leukocytes. Antitoxins, substances 
formed in the body that are antidotal to bacterial toxins. 
Bacteriolysins, substances resulting from the union of two 
bodies known as complement and addiment that produce the 
solution of bacteria. Antiseptic substances present in the 
blood serum and tissues that restrain bacterial growth. 

What is immunity? How is immunity produced? 

Immunity expresses the degree of resistance of the living 
organism against disease. It is produced by attacks of dis- 
ease, by the introduction into the body of living or dead bac- 
teria or their products, or of antitoxins or by heredity. 

Give the pathologic changes occurring in acute phlebitis. 

Congestion of vessels of vasa vasorum and effusion in the 
walls of vein of serum and leukocytes, with formation of 
thrombus within vessel. This may terminate in absorption 
and resolution, the permanent occlusion of the vein, or in 
suppuration. 

What conditions (nontraumatic) favor cerebral hemor= 
rhage? Mention the vessel from which cerebral hemor= 
rhage occurs most frequently. 

a. Arterio-sclerosis or aneurysm of cerebral vessels and 
their causes, cerebral tumor, infarction, whooping cough or 
■convulsions, leukemia, pernicious anemia. 

b. The left lenticulo-striate artery. 

(307) 



308 PATHOLOGY AND BACTERIOLOGY. 

Give the histologic characteristics of amyloid degen- 
eration. [ 

The amyloid substance appears in the form of irregular 
homogeneous, translucent, faintly granular areas of fused 
cells and intercellular substance affecting chiefly the con- 
nective tissues about the capillaries, as in the glomerules of 
kidney or spleen. The adjacent epithelial cells may show 
atrophic changes or fatty degeneration. The urinary tubules 
may contain amyloid casts. 

What are the blood changes in progressive pernicious 
anemia? 

A marked and disproportionate oligocythemia, slight leu- 
copenia, poikilocytosis, and the presence of nucleated red 
corpuscles. 

^ Give the gross and the microscopic appearance of an 
epithelioma of the lip. 

A crushed papule or warty growth, with infiltrated base, 
that tends to undergo crater-like ulceration. Microscopically, 
an invasion of the subcutaneous and deeper tissues by irreg- 
ular columns composed of squamous epithelial cells that often 
contain pearly bodies is seen. 

Give the functions and the products of bacteria. 

Functions are reproduction, motion, absorption, excretion,, 
growth; also fermentation, decomposition, disease-production.. 
They may produce as products ferments, toxins, phosphores- 
cence, pigments, acids or alkalies* 

Give the causes of edema. 

Passive hyperemia, anemia, change in vessel walls or in 
vascular innervation, reduction in extra-vascular pressure, 
lymphatic obstruction. 

- What are cysts? How are cysts formed? Give the 
varieties of cysts. 

Abnormal, persistent, encapsulated collections of liquid 



PATHOLOGY AND BACTERIOLOGY. 309 

formed by obstruction to outlet of glands by secretion in a 
cavity without outlet, extravasation of blood or other liquid, 
softening of tissues, tumor formation, or by the presence of a 
parasite or foreign body. Varieties are simple, compound, 
and proliferous, congenital, retention, extravasation, soften- 
ing, neoplastic and parasitic cysts. 

What is the special cause of the croupous inflammation 
found in diphtheria? 

The toxin of the diphtheria bacillus. 

Describe the comma bacillus and give the manner of its 
introduction into the system. 

A spirillum, a short, curved rod .8 to 2 microns in length, 
motile, flagellate, readily staining but decolorized by Gram's 
method, usually enters through the alimentary canal with 
contaminated water, milk or solid food. 

What conditions give to the system immunity from the 
harmful action of bacteria? 

The bacteriolysins, the antitoxins, the phagocytes, the anti- 
septic action of tissue cells and juices, the protecting layers 
of epithelium. 

(a) Give the microscopic appearance of a melano=sar= 
coma and (b) state its usual sites of development. 

(a) Consists usually of vascularized tissue consisting of 
spindle cells, or at times of round cells, that have vesicular 
nuclei, and many of which contain dark pigment granules. 
(b) Skin and choroid. 

Describe the pathologic conditions in meningitis. 

An inflammation of the membranes of brain or cord char- 
acterized by congestion of meningeal vessels, edema of arach- 
noid, effusion of serum, fibrin, or pus into the cavity of arach- 
noid, at times petechial or larger hemorrhages within or with- 
out arachnoid. Adjacent degeneration of nervous substance 
■may occur. 



310 PATHOLOGY AND BACTERIOLOGY. 

Give the pathology of cirrhosis of the liver. 

A marked hyperplasia of the interlobular connective tissue^ 
and often of interlobular bile ducts. The new-formed con- 
nective tissue tends to contract, compressing the lobules and 
perhaps causing degeneration of the hepatic cells. The liver 
may become much smaller and show a rough ("hob nail") 
surface. 

(a) How is fibrous tissue formed? (b) What tumors 
are composed largely of fibrous tissue, and in what part of 
the body do they usually occur? 

(a) By a proliferation of cells of the pre-existing, adjacent 
fibrous tissue. The young cells or fibroblasts being nourished 
by new capillary blood-vessels that sprout from neighboring 
pre-existing vessels and invade the formative area. 

(b) Fibromas and fibromyomas chiefly occur in the uterus. 

What is the significance of tube=casts in the urine? 

Tube-casts result from irritative and degenerative changes 
in the epithelium of kidney, permitting an exudation of coag- 
ulable substance into the tubules, and signify renal irritation 
or disease. They are minute cylindric bodies having a homo- 
genic matrix, in which there may be imbedded cellular or 
granular particles. 

Describe yellow or crude tubercle. 

A yellowish, rounded, firm, adherent body, one to several 
millimeters in diameter, showing under microscope a central 
caseous area, an intermediate zone of epithelioid cells and 
often giant cells, and a peripheral zone of lymphocytes. 

Give the structural differences between sarcoma and 

carcinoma. 

* 

Sarcoma consists of connective tissue of embryonic type 
containing imperfectly formed blood-vessels. Tissue may 
consist of round, oval, spindle or, in part, of giant cells. 

Carcinoma is less circumscribed, consists of alveoli filled by 
cuboidal, columnar or squamous epithelial cells in a stroma.. 



PATHOLOGY AND BACTERIOLOGY. 311 

usually of fibro- connective tissue, that contains well-informed 
blood-vessels and lymphatics. 

Define anemia, hyperemia, leukemia. 

Anemia is deficiency in the quantity or quality of circulat- 
ing blood. 

Hyperemia is an excessive quantity of circulating blood in 
a part. 

Leukemia is a grave primary anemia characterized by enor- 
mous leucocytosis and pathologic changes in the spleen, red 
marrow or lymphatics. 

State the difference between degeneration and infiltra= 
tion. Illustrate. 

Cell degeneration is a condition in which the cell contents 
become abnormal. If abnormal from the deposit of substance 
from without it is termed cell infiltration, as in fatty infiltra- 
tion. If abnormal from transformation of cell contents it is 
termed a cell metamorphosis, as in fatty metamorphosis. 
Fatty infiltration and fatty metamorphosis are both examples 
of cell degeneration. 

Give the morbid anatomy of chronic bronchitis. 

Mucous membrane may be red and thickened and covered 
by thick mucus; or pale, thinned, and showing adherent, in- 
spissated mucous masses. The thickening is due to leuco- 
cytic infiltration and overgrowth <5f fibrous tissue; the thin- 
ning to atrophy of the mucous membrane. The ciliated cells 
may be replaced by columnar or polygonal epithelium. 

What is thrombosis? Describe the manner of its for= 
mation. 

Thrombosis is the intravascular coagulation of blood during 
life resulting from the arrest of circulation and the formation 
of fibrin by the action of fibrin ferment upon the fibrinogen. 

(a) What is mucoid degeneration? (b) What is col= 
loid degeneration? 

(a) A conversion of cells and intercellular substance into 
mucin. 



312 PATHOLOGY AND BACTERIOLOGY. 

(b) A conversion of cells into colloid material, a substance 
resembling mucin but not giving its reaction. 

State the results of stenosis of the tricuspid valves of 
the heart. 

Dilatation of right auricle, cyanosis of face, passive hy- 
peremia of pulmonary and abdominal organs, anasarca. 

(a) Define fatty metamorphosis, (b) Give its termin= 
ations. 

(a) Conversion of cells into fat. 

(b) Destruction of cells, colliquation or caseous necrosis. 

What are the possible lesions in the third stage of 
syphilis? 

Grummata, syphilitic rupia, sclerotic changes in organs, 
especially the arteries, liver, kidneys and spinal cord. 

Describe the local appearances in a case of embolism of 
the middle meningeal artery. 

The affected vessel contains thrombus extending from the 
seat of embolism back as far as the first collateral branch. 
The distal branches may be shrunken, anemic, and associated 
with cerebral softening or distended, and in the midst of a 
hemorrhagic effusion (hemorrhagic infarction). 

What is productive inflammation? 

Inflammation characterized by the formation of new tissue, 
usually of the fibro-connective tissue type. 

What changes take place in hypertrophy of the heart? 

An increase in thickness of the muscular walls of the heart, 
chiefly affecting the ventricle, blunting the apex. The cavi- 
ties may or may not be increased in size. 

Give the origin and appearance of papillomata. 

Originate from overgrowth of the papillary body, and are 
wart-like, villous, dendritic or polypoid outgrowths from skin 
or mucous membrane covered by epithelium. 



PATHOLOGY AND BACTERIOLOGY. 313 

Briefly describe the types of gangrene, and give the 
conditions determining each. 

Dry gangrene or putrefactive death of a part with mummi- 
fication is characterized by a dry, shriveled, blackish, leathery, 
friable area, and is caused by arterial obstruction, such as 
occurs in old age (senile gangrene), from arterio-sclerosis, in 
Raynaud's disease, from ergot poisoning and frostbite. 

Moist gangrene is characterized by swollen, greenish or 
blackish, cool, moist, soft, fetid area, with bleb-covered sur- 
face, loosened epidermis and crepitation on palpation, and is 
due to severe infection (pulmonary gangrene, malignant pha- 
gedena, hospital gangrene), trauma, venous obstruction, dia- 
betes (diabetic gangrene), and deficient trophic innervation 
(decubitus). ^ 

Describe the histological elements of carcinoma. 

Acini containing epithelial cells. The amount of protoplasm, 
as in other epithelial cells, is large in proportion to the size of 
the nucleus. Cells may be squamous cylindric, cuboidal or 
polyhedral. The nuclei are usually vesicular and atypical 
karyokinetic, and other cell figures may be present. The 
stroma usually consist of well-formed fibro-connective tissue 
containing lymphatics and well-formed blood-vessels. 

Describe tuberculosis of the skin in any of its forms. 

Lupus vulgaris is characterized by brown nodules originat- 
ing in corium, and consisting of a rather vascular granula- 
tion tissue composed of epithelioid cells, lymphoid cells, and 
frequently of giant cells. The nodules may lead to extensive 
ulceration and cicatrization. 

Describe the changes in the heart due to fatty meta= 
morphosis. 

Diffuse or circumscribed, yellowish, opaque, soft, friable 
areas of heart muscle, in the circumscribed form chiefly occur- 
ring under endocardium of papillary muscles. Microscopic- 
-ally, the muscle fibres lose their striation and show fatty 



314 PATHOLOGY AND BACTERIOLOGY. 

granules, usually first about the nuclei; finally fibres may 
break down into fatty particles and detritus. 

What histological changes occur in acute simple inflam= 
mation? 

Dilatation of blood-vessels, retardation and stasis of blood 
current, exudation into tissues of modified plasma, transmi- 
gration of leukocytes, and often diapedesis of erythrocytes, 
distension of lymphatics by exudate of cells and fluid, regen- 
erative or degenerative ebanges in the tissue cells. 

Give the pathology of carcinoma. 

Carcinoma is a malignant, uncircumscribed tumor consist- 
ing of acini, containing invaded epithelial cells in a vascular- 
ized stroma that usually consists of fibro-connective tissue. 
The epithelial cells tend to a progressive invasion through 
the lymphatic channels. 

What is fibrinous degeneration? 

A retrogressive process in which, by the action of fibrin 
ferment upon fibrinogen, fibrin is formed. 

What do you understand by the term cirrhosis of the 
liver? 

Overgrowth in the liver of connective tissue that contracts, 
rendering the organ smaller and firmer. 

Is cerebro=spinal fever more generally sporadic or en= 
demic? 

Cerebro-spinal fever generally occurs in the form of small 
sporadic epidemics. 

Give some of the lesions in chronic diffused or inter= 
stitial nephritis. 

Macroscopic. Small, granular-surfaced kidney with adhe- 
rent capsule and thinned cortex. 

Microscopic. Thickening of Bowman's capsules, hyaline 
degeneration of glomerules, increase of intertubular tissue, 
dilatation of certain tubules. 



PATHOLOGY AND BACTERIOLOGY. 315 

What anatomic changes take place in the skin in chronic 
eczema? 

Enlargement of papillae, dilatation of blood and lymph 
vessels, perivascular cellular infiltration, hyperplasia of con- 
nective tissue and epithelium, atrophy of sebaceous and sweat 
glands. 

What are the characteristic features of diphtheritic ex= 
udation or infiltration of mucous membrane? 

The layers of mucous membrane undergo coagulation ne- 
crosis, and are infiltrated by a granular or fibrillar exudation 
of fibrin, and by leukocytes. 

What abnormal organic ingredients are found in the 
urine in chronic morbus Brightii? 

Tube casts — hyaline, granular or cellular; cylindroids, 
epithelial cells from urinary tubules, albumin, and at times 
leukocytes and erythrocytes. 

In what general respects do " anemia and progressive 
pernicious anemia " differ? 

Anemia refers to any blood impoverishment. Pernicious 
anemia is a very serious type of an essential anemia in which 
there is a disproportionate oligocythemia. In most anemias 
this is proportionate to the oligochromemia. 

What is cretinism, and with what is it associated? 

A disease developing in early life characterized by disten- 
sion (at times myxomatous) of subcutaneous tissues and by 
general mental and physical ill development, that is always 
associated with abnormality or absence of the thyroid gland. 

How should sputum be examined for tubercle bacilli? 

A selected portion of morning expectoration is thinly spread 
on a cover-glass,, dried, fixed by heating, stained for three 
minutes in hot carbol-fuchsin, washed, decolorized and coun- 
ter-stained for one-half minute in Gabbet's solution, washed, 
dried, mounted in balsam, and examined under a one-twelfth 



316 PATHOLOGY AND BACTERIOLOGY. 

oil immersion objective for minute red rods — the tubercle 
bacilli. 

What is infective inflammation? How does it differ 
from simple inflammation? 

Infective inflammation is that form due to the action of 
bacteria, while simple inflammation is not due to micro- 
organisms. Infective inflammation tends to spread, is more 
severe, and is often associated with marked constitutional re- 
action, the reverse being the icase in simple inflammation. 

Give the morbid anatomy of acute lobar pneumonia. 

In engorgement (first stage) the affected lobe is deep red, 
boggy, slightly crepitant, and on section exudes bloody serum ; 
this passes into red hepatization (second stage), in which 
the affected lobe is dark red, solid, airless, friable, with dry, 
granular surface of section, while in gray hepatization (third 
stage) the lobe is grayish- white, solid, friable, with moister 
surface of section. Microscopically, in the first stage, there 
is intense hyperemia, with presence of serous liquid and red 
and white corpuscles in alveoli. In the second stage the air 
cells are filled by red and white corpuscles entangled in 
coagulated fibrin, while in the third stage the fibrin, erythro- 
cytes and hyperemia disappear and the alveoli are distended 
by leukocytes and granular detritus. Resolution (fourth 
stage) is characterized by liquefaction necrosis, absorption 
and expulsion of exudate. 

Give the causes and process of cerebral softening. 

The chief causes are the obstruction of cerebral arteries by 
an embolus, thrombus or arterio-sclerosis. The area thus ren- 
dered anemic degenerates and undergoes eolliquation necrosis, 
and if pyogenic bacteria are present an abscess may form. 

Describe the rash and give the morbid anatomy of scar= 
latina. 

Scattered red points on a deep reddish base appear over 
neck and chest by the second day, spread over the body, and 



PATHOLOGY AND BACTERIOLOGY. 317 

after three or four days gradually fade, to be followed by 
desquamation. There are no specific lesions, but usually 
acute catarrhal or pseudo-membranous pharyngitis, acute 
diffuse nephritis, and often follicular tonsillitis, lympha- 
denitis (at times suppurative), catarrhal gastro-enteritis, in- 
terstitial hepatitis, splenic enlargement, and as complications, 
purulent otitis media, endocarditis, pericarditis, broncho- 
pneumonia. 

What is a giant cell? Give characteristics. 

A very large icell with many nuclei, found in the tubercle, 
in gumma, in bone marrow, and in myeloid sarcoma. It is 
irregular, and often indefinitely outlined, with hyaline proto- 
plasm and from four to one or two hundred nuclei, that may 
be (as in tubercle) arranged peripherally, equatorially, at 
the poles or (as in sarcoma) near the center of the cell. 

Describe the formation of adipose tissue. 

In protoplasm of connective tissue cells, fat droplets that 
tend to coalesce and displace the nucleus are deposited. 
Finally the nucleus is displaced to extreme periphery of cell 
and may disappear, while the cell is transformed into a dis- 
tended sac filled by fat. If this take place, in many adja- 
cent connective tissue cells adipose tissue results. 

What pathological changes occur in caries? 

In caries (rarefying ostitis) there is a solution of bone with 
or without the formation of pus. A round-celled infiltration, 
often with the formation of granulation tissue, occurs in 
medulla and in Haversian canals with solution of soft and 
hard structure of bone, the ended pits being Howship's 
lacunse. 

How is dental caries produced? 

Acids (especially lactic) formed by bacteria present in the 
saliva acting upon starchy particles, progressively dissolve 
the mineral structure of the tooth, whereupon saprophytic 
micro-organisms present cause solution of the organic sub- 
stance of the tooth. 



318 PATHOLOGY AND BACTERIOLOGY. 

- Describe catarrhal inflammation. 

An inflammation of a mucous surface, with the fluid exuda- 
tion consisting of mucus, serum, leukocytes and desquamated 
epithelial cells in varying proportions. The area affected is 
red, swollen and bathed by exuded secretion. 

What is the line of demarcation in gangrene? 

The zone of inflammatory reaction observed in the living 
tisue adjacent to the gangrenous area. 

What is the line of separation in gangrene? 

The narrow zone of progressive ulceration and molecular 
disintegration distal to the line of demarcation that tends to 
sever the connection between the living and dead tissues. 

What post=mortem changes occur in the tissues? 

Rigor mortis, algor mortis, livores mortis, muscular relaxa- 
tion, formation of adipocere, decomposition. 

Define atrophy. Give the varieties of atrophy. 

The diminution in size and functional capacity of a part. 
It may be simple or degenerative, passive, active, senile, pres- 
sure or neuropathic atrophy. 

Differentiate fatty infiltration and fatty degeneration. 

In fatty infiltration the fat is from without affected cells, 
and appears as fat droplets that coalesce, displace and obscure 
the nucleus, and distend, but do not entirely destroy, the cells. 
In metamorphosis the cell protoplasm is converted into fat 
that appears in the form of granules or minute droplets that 
tend to cause the breaking down and destruction of proto- 
plasm and nucleus. 

Define fibromata. Give the histology of fibromata. 

A tumor of the type of fibro-connective tissue, showing 
under the microscope whorls or curving bundles of long, nar- 
row fibers having occasional narrow spindle-shaped nuclei. 
As a rule, fibromas are encapsulated and not very vascular. 



PATHOLOGY AND BACTERIOLOGY. 319 

Give the varieties, the histology, and the physical char= 
acteristics of lipomata. 

a. Diffuse and ■circumscribed, sessile or pediculated. 

b. Resembles normal adipose tissue, consisting of fat-dis- 
tended cells supported in a light fibro-connective tissue frame- 
work. 

c. Greasy, lobulated, yellowish, encapsulated, soft growths. 
The overlying skin "dimples" when elevated. 

What part of the cord is involved in locomotor ataxia? 
Give the pathology of locomotor ataxia. 

a. Posterior columns. 

b. In columns of Goll and Burdach areas of degeneration 
showing destroyed myelin sheaths and axis cylinders and a 
proliferation of neuroglia occur. 

What are the intestinal changes in chronic enteritis? 

The mucous membrane and muscular wall may show hyper- 
plastic thickenings or atrophy. Enlargement of lymph fol- 
licles is frequent, and polypoid masses may project from 
mucous membrane. Ulcers may be present. 

Define myomata, neuromata, angiomata. 

a. Myomata are tumors of the type of muscle. 

b. Neuromata are tumors of the type of nerve tissue. 

c. Angiomata are tumors of blood or lymph vessels. 

Explain the development of pus corpuscles. 

Migrating leukocytes pass through the walls of the adja- 
cent capillaries, and in large numbers invade the area of sup- 
puration, and whether living or dead as soon as they are sur- 
rounded by liquor puris are termed pus corpuscles. 

Give the pathology of spina bifida. 

The spinal lamina being congenitally imperfect, the con- 
tents of the spinal canal tend to protrude in the form of a 
tumor. The mass usually contains fluid, and is covered by 
the attenuated cord, nerves, or by the membranes alone. 



320 PATHOLOGY AND BACTERIOLOGY. 

Spina bifida occulta is a form in which the vertebral cleft i& 
unasociated with the formation of a tumor. 

What are the pathologic conditions in gonorrheal op= 
thalmia? 

A purulent conjunctivitis with marked chemosis, edema of 
eyelids, profuse purulent discharge, and as complications, 
ulcerative or suppurative keratitis, with or without resulting 
perforation, anterior synechia, leucoma, staphyloma, iritis, 
hypopyon. 

What are the pathologic appearances of anemia of the 
brain? 

The blood-vessels are empty or imperfectly distended by 
blood, and if the process has been long continued the brain 
may show atrophy or degenerative changes in the involved 
areas. 

What is embolism? 

Intravascular obstruction from the lodgment of a foreign 
body. 

What is an infarct? 

The area of degenerative and inflammatory changes pro- 
duced by the lodgment of an embolus in an end artery. 

Describe the pathologic conditions present in atheroma. 

A diffuse or circumscribed mesarteritis occurs with involve- 
ment of vasa-vasorum and .the production of new sclerotic 
tissue that undergoes coagulation necrosis and fatty degener- 
ation. This softened degenerative material is termed athero- 
matous. It may become calcified, be discharged with the- 
formation of an atheromatous ulcer or cause a weakening of 
the. wall, favoring rupture or aneurysm formation. 

What structural changes take place in chronic gout? 

Polyarthritis, with deposits of urate of sodium in articular 
cartilages, and about joints with formation of concretions, 
(tophi). Arterio-sclerosis, hypertrophy of left ventricle and 



PATHOLOGY AND BACTERIOLOGY. 321 

sclerotic changes in liver and kidneys are common, and there 
is a tendency to inflammation of the larger serous sacs. 

What are the four cardinal indications in inflammation? 

Heat, swelling, redness and pain, to which may be added 
altered function. 

Define ascites. 

An abnormal collection of serous fluid in the peritoneal 
cavity. 

What condition of the blood is generally prominent in 
all forms of gout? 

Excess of sodium urate. 

Give some of the causes (pathologic) of paresis. 

A chronic, progressive meningoencephalitis characterized 
by a productive arteritis involving especially the adventitia, 
with degenerative atrophy and sclerosis of cortex and sub- 
cortical portions of brain. Degenerative changes in spinal 
cord are associated. 

What is the pathology of aneurysm? 

A localized enlargement of an artery containing blood or 
clot, due to a circumscribed stretching of one or all the coats of 
a vessel. It occurs in vessels weakened by trauma, arterio- 
sclerosis, mycotic inflammation, or by ulceration, or proximal 
to areas of thrombosis or embolism. The vessel walls forming 
the aneurysm are thinned, often calcified, with impaired elas- 
ticity, and usually having thicker or thinner lining of adhe- 
rent, laminated fibrin. 

Describe the pathological conditions in icterus. 

The skin, conjuctivse, urine, blood and the various organs 
are tinged a yellow color by the biliary pigment, The feces 
are usually clay-colored. The pulse is slow; there is a ten- 
dency to hemorrhage. 

Define the term malignant as applied to new formations. 

New growth having an inherent tendency to a fatal issue. 
21 



322 PATHOLOGY AND BACTERIOLOGY. 

Give the pathology of peritonitis. 

The peritoneum is red from vascular injection, the surface 
is dull, and may be covered by adherent fibrinous or purif orm 
exudate. The cavity of the peritoneum contains serum, in 
which there may be fibrin or pus. There is a tendency for 
adjacent peritoneal surfaces to adhere, localizing the process. 

What is understood by the phrase " new formation "? 

A multiplication of certain cells of the body producing a 
mass of tissue that has no place in the normal organism, such, 
for example, as a tumor. 

By examining the fluid removed by lumbar puncture, 
how may we distinguish between tubercular and other 
forms of meningitis? 

In tuberculous meningitis the fluid contains chiefly lympho- 
cytes, and by staining, or inoculation into animals, the pres- 
ence of the tubercle bacillus may be demonstrated. In other 
forms of meningitis the cerebro-spinal fluid, as a rule, is more 
turbid, contains chiefly polymorpho-nuclear leukocytes, and 
the causal organisms, as the pneumococcus, the diplococcus 
intracellularis meningitidis or other bacterium, but not the 
tubercle bacillus. 

Differentiate a tuberculous joint from one enlarged by 
chronic rheumatism. 

Tuberculous joint-disease occurs chiefly in children, affects 
usually but a single joint, has insidious onset, with slight and 
often characteristically reflected pain, and muscular rigidity; 
is persistent, and tends to cause flexion and pale, doughy 
thickening of joint, with later the formation of cold abscess 
and sinuses. Eheumatism usually involves several joints, 
has acute onset, is transient, with marked localized tender- 
ness, and if severe, redness and swelling. 

What part of the spinal cord is involved in progressive 
muscular atrophy? 

The anterior horns of the gray matter. 



PATHOLOGY AND BACTERIOLOGY. 323 

What are the degenerative changes of arteries? 

Calcareous infiltration, hyaline, fatty and amyloid degen- 
eration. 

What pathologic changes may cicatrices undergo? 

Cicatricial contraction or distension, cicatricial keloid, 
cicatricial carcinoma, abscess and ulceration. 

What is ischemic paralysis? 

The loss of voluntary motion in a living part, the result of 
local anemia. 

Differentiate between a tubercular and typhoidal ulcer 
of the small intestine. 

The tubercular ulcer results from the action of the tubercle 
bacillus, is chronic, tends to have a long axis transverse (annu- 
lar ulcer) to bowel, to show outlying tubercles and irregularly 
thickened edges and base. The typhoid ulcer results from 
the action of the bacillus of Eberth, tends to have its long 
axis parallel to gut, to have undermined edges and thin floor, 
and often causes hemorrhage or perforation. 

Distinguish between burns inflicted on a body before 
death and those inflicted after death. 

Vesicles containing albuminous serum and an adjacent red 
zone of inflammatory reaction indicate infliction of burn dur- 
ing life, and are absent in case of burns produced after death. 

Give the causes of hemorrhage. 

Increased blood pressure, atheroma, aneurysm, fatty, calca- 
reous, inflammatory change or malignant infiltration of vessel 
wall, embolism, traumatism, hemophilia, scurvy, typhus fever, 
venoms, phosphorus poisoning, and anomalous innervation, 
as in hysteria. 

What are the causes of lymphorrhagia? 

Lymphatic obstruction or injury, as may result from 
trauma, pressure of neoplasms, aneurysms or inflammatory 
tissue, or obstruction by filaria or other parasites. 



324 PATHOLOGY AND BACTERIOLOGY. 

How does calcareous degeneration of the arteries influ= 
ence the circulation? 

Increases arterial pressure and the work of heart, causes 
imperfect blood supply, at times leading .to gangrene, and 
favors thrombosis and hemorrhage (hemiplegia). 

What are pyogenic bacteria? 

'Schizomycetes capable of inaugurating suppuration. 

What changes take place in simple atrophy of the liver? 

A reduction in size, with preservation of general outlines, 
and without noteworthy increase of stroma, or degenerative 
change in the liver cells. 

Describe syphilitic gummata. 

Rounded, soft or firm, grayish or yellowish, circumscribed 
masses, from five mm. to several icm. in diameter, surrounded 
by ian area of fib ro- connective tissue, and consisting of a typ- 
ical granulation tissue showing mucoid degeneration or cen- 
tral caseous necrosis. 

What changes characterize inflammation of bone? 

An absorption of bone, with the ingrowth of new granu- 
lation tissue (rarefying ostitis) or possibly abscess forma- 
tion, or a progressive ossification with resulting thickening 
and condensation (condensing ostitis). 

Where and what are the pathologic changes in bulbar 
paralysis? 

Degenerative atrophy and sclerosis, with shrinking of 
motor cells and degeneration of processes, affecting the glosso- 
labio-laryngeal nucleus in the medulla. 

Give the pathologic changes in sclerosis of nerves. 

An overgrowth of the supporting connective tissue and 
neuroglia, with thickening of blood-vessel walls and atrophic, 
fatty or other degenerative changes in myelin sheaths and 
axis cylinders. 



PATHOLOGY AND BACTERIOLOGY. 325 

^ (a) What features render a tumor malignant? (b) 
Mention some of the growths considered malignant. 

(a) Invasion of adjacent tissue, reeidivity, metastasis, the 
production of cachexia. 

(fc) Carcinoma, sarcoma, endothelioma. 

^ What is lardaceous (amyloid, waxy, bacony) degener= 
ation? 

The transformation of tissue into a homogeneous, wax-like 
albuminous material, giving a mahogany-brown color with 
dilute Lugol's solution. 

What is the pathology of plastic inflammation? 

A modified serum, leukocytes and at times erythrocytes 
escape from the vessels. The fibrin factors in this exudate 
unite, producing fibrin that may cause adhesion between con- 
tiguous viscera. Later this plastic exudate may break down, 
or, if it be replaced by new fibro-conneetive tissue, more or less 
permanent adhesions may result. 

What are some of the results of lymphorrhagia? 

Chylous extravasation, lymph fistulae, chyluria, chylothorax, 
chylous ascites, malnutrition, death. 

What conditions may result from enlargement of lymph 
spaces or lymph vessels? 

Capillary, cavernous or cystic lymphangioma, cystic hy- 
groma ("hydrocele of the neck"), macroglossia (of tongue), 
macrocheilia (of lip), elephantiasis, lymph scrotum. 

What inflammatory conditions may result in enlarge= 
ment of the lymphatic glands? 

Infection by pyogenic bacteria, plague, syphilis, tubercu- 
losis. 

What noninflammatory condition may produce enlarge= 
ment of lymph glands? 

Hodgkin's disease (pseudoleukemia), leukemia (especially 
lymphatic types), lymphadenoma, secondary tumors (carci- 
noma, sarcoma) in lymph glands. 



326 PATHOLOGY AND BACTERIOLOGY. 

Give the pathologic features of mechanical hyperemia 
of the. liver (nutmeg liver). 

A chronic, passive hyperemic condition resulting from val- 
vular heart disease, emphysema, pleuritic exudations, aneu- 
rysm, or other obstructions to venous return. The liver is 
more or less enlarged and is deeply mottled, this being due to 
the distension of the capillaries near the center of the lobules 
by blood, often with atrophy of the adjacent hepatic cells, 
while the liver cells at the periphery of the lobules may show 
fatty or other degenerative changes. 

Describe the formation of an acute abscess. 

By stages : 1. Local tissue irritation, usually from the pres- 
ence of pyogenic bacteria. 2. Exudation of modified serum 
and many leucocytes, 3. Colliquation necrosis in affected 
area, resulting in the formation of cavity (abscess) filled with 
a liquid (pus), consisting of fluid part (liquor puris) and 
many dead and living leucocytes (pus cells). 

Describe symbiosis with special reference to patho= 
genesis and cite an example. 

Symbiosis refers to 'the modifications in the activities of 
different species of bacteria resulting from their association 
as compared with their activities when in pure culture. Thus, 
the injurious affects of the tubercle bacilli upon the tissues 
are greatly increased when the bacilli are in association with 
streptococci or staphylococci. Upon the other hand, anthrax 
bacilli become less virulent when mixed with cultures of 
Bacillus prodigiosus. 

Give a general description of the action of agglutinins. 

Agglutinins are substances observed chiefly in the blood 
serum of infected animals, which when brought in contact with 
living or dead bacteria of the same species as those having pro- 
duced the infection, cause the bacteria to become immotile, and 
to agglutinate or collect in clumps. The action is usually 
specific; that is, it occurs only against bacteria of the same 



PATHOLOGY AND BACTERIOLOGY. 327 

species as that causing the infection. It is not necessarily 
associated with the death of the bacteria, and as agglutinins 
may be produced by the action of bacteria upon culture 
media, the animal body is not essential to their formation. 

Describe the process of ulceration. 

Ulceration or the production of an ulcer is an inflammatory 
process in which a definite loss of substance from a surface 
of the body is produced. The area may be destroyed by the 
injurious action of physical or animate agents, by interfer- 
ences with the circulation, or as a result of the progress of 
tumors. The tissue of the involved area is first removed by 
processes of necrosis, or mechanically. The area left has 
borders of more or less healthy tissue which become the 
seat of extension or of healing of the ulcer; and a floor or 
base, wmich usually becomes occupied by granulations, or, 
if the ulcer be progressive, by necrotic and sloughing tissues. 
Ulceration may be a chronic, indolent process, may be pro- 
gressive, leading to extension of the ulcer, or as usually 
occurs, it becomes arrested and cicatrization, or healing of 
the area, occurs. 

Describe the changes that occur in cartilage in arthritis 
deformans. 

The cartilage becomes softened, fissured, and develops sur- 
face excavations which may extend deeply into the bone. 
Simultaneously, other cartilage cells may proliferate and pro- 
duce nodular, cartilaginous projections. Medullary spaces 
invade the degenerating and proliferating cartilage, and it is 
transformed in part into osteoid tissue. Villous or nodular, 
fatty, calcareous or bony outgrowths may spring from the 
synovial membrane, and if they become detached, form free 
joint bodies. The bones making up the joint become more 
flattened, more porous, excavated, or the seat of new bony pro- 
cesses; and fibrous ankylosis, subluxation or luxation fre- 
quently follow. 



328 PATHOLOGY AND BACTERIOLOGY. 

Enumerate the most ordinary senile changes that occur 
in the various tissues of the body. 

In organs, atrophy and increase of fibro-eonnective tissue 
elements. In bones, absorption of oseous tissue, and cer- 
tain (changes in form, especially noted in the edentulous man- 
dible, and in the neck of the femur. In walls of arteries and 
veins, arteriosclerotic changes, with tendency to calcification. 
In joints, degenerative changes, resembling rheumatoid arthri- 
tis of a mild type. In skin and adipose tissue, wasting and 
atrophy. 

Describe how mitral stenosis and aortic regurgitation 
respectively affect the cavities and musculature of the 
heart. 

In mitral stenosis, as the left ventricle receives insufficient 
blood, it may atrophy. As the left auricle insufficiently 
empties, it hypertrophies and dilates. Secondarily, the back 
pressure through the lungs increases the work of the right 
ventricle, which hypertrophies. The cavities of the right 
ventricle and left auricle are increased and their walls are 
thickened. The cavity of the left ventricle decreases in size, 
and has unaltered or thinned walls. In aortic regurgitation, 
much of the blood which has left the left ventricle is per- 
mitted to return, so that the ventricle receives not only the 
normal blood from the left auricle, but also the return leak 
from the aorta. This results in distension of the cavity and 
compensatory hypertrophy. This may cause an enormous in- 
crease in the thickness and size of the ventricle. Eventually 
the ventricle becomes incompetent, or in its distension pro- 
duces mitral insufficiency, and there ensues an auricular 
hypertrophy, and dilatation, pulmonary congestion, and finally 
distension and hypertrophy of the right heart. An enormous 
heart ( cor-bovinum) may thus be produced. 

Describe the bacillus tuberculosis, its habitat, mode of 
growth and method of detection. 

The tubercle bacillus has the form of a minute, slightly 



PATHOLOGY AND BACTERIOLOGY. 329 

curved rod, with rounded ends, and an average measurement 
of 2 x .35 microns. It occurs singly and in small groups. Its 
habitat is the tissues of vertebrates. Precise knowledge of its 
natural growth outside of the body is wanting. Its growth 
under artificial cultivation is slow, requiring several weeks 
for icolonies to develop, and necessitates special media, such 
as glycerine agar, or special blood serum. Pale gray or yel- 
lowish, dry, wrinkled, rather firm, crustlike, surface masses 
are formed by the growth of the bacteria. Growth usually 
occurs only at a temperature ahout that of the body, in 
the absence of strong light, and in the presence of free 
oxygen. 

It is detected — (a) by inoculating guinea-pigs with some 
of the suspected material, and six weeks later killing them 
and searching for the characteristic lesions of tuberculosis. 
Or — '(b) by staining spread smears of suspected material three 
minutes with hot carbol-f uchsin and decolorizing for five min- 
utes with a three per cent, solution of HC1, in absolute al- 
cohol. Tubercle bacilli retain the red fuchsin color after this 
treatment, while nearly all other bacteria are decolorized. 

Describe the microscopic appearances of acute paren= 
chymatous nephritis and explain the origin of blood in 
the hemorrhagic form. 

The microscopic changes may be chiefly of the glomerules 
— glomerulo-nephritis, or in convoluted tubules — tubulo-ne- 
phritis, or may affect all the parenchyma. In the capsular 
spaces are glomerular or desquamated epithelial cells, leuko- 
cytes, erythrocytes and plastic or granular exudate. The 
epithelial cells may show cloudy swelling, fatty metamor- 
phosis, or karyokinetic changes indicating regenerative ef- 
forts. Where the walls of the vascular tuft in the glomerulus 
give way, a hemorrhage occurs, distends the capsules, flows 
down the renal tubules, coagulates there, and forms blood 
casts. The cells lining the tubules (especially the convoluted) 
show cloudy swelling, fatty metamorphosis, or even necrosis, 



330 PATHOLOGY AND BACTERIOLOGY. 

and hyaline, granular, cellular, or hemorrhagic casts fill the 
tubules. 

Describe the pathologic histology of amyloid liver and 
state where the deposit occurs. 

The amyloid substance is formed in the connective tissue 
framework of the liver, appears in or about the walls of the 
capillaries, as anuclear, homogeneous cylinders, and as irregu- 
lar wax-like masses in the tissues which displace the cells of 
the parenchyma, and perhaps favor the atrophic, fatty, de- 
generative changes that they show. The amyloid substance 
does not take the usual nuclear stain, but is given a reddish 
color by gentian violet. 

Describe the lesions characteristic of chronic alcoholism. 

The lesions produced by chronic alcoholism also occur from 
other toxic causes, and it is difficult to state that any are 
absolutely characteristic of alcoholism alone. In the nervous 
system a form of multiple, peripheral neuritis (alcoholic 
neuritis) characterized by swelling, redness, infiltration, and 
degeneration that may be perineural or interstitial, occurs. 
The myelin may be degenerated, and the axis cylinders show 
varicosities or granular degeneration, and finally may be 
destroyed and replaced by connective tissue that is sometimes 
infiltrated with fat. In the central nervous system opaque 
thickening of the meninges with wasting of the cerebral 
convolutions, are common. Hemorrhagic pachymeningitis 
may also result. The liver may be reduced in size with irre- 
gular surface, increase of connective tissue framework, and 
degeneration of parenchyma (gin- drinkers' liver). The typi- 
cal beer drinkers' liver is a much enlarged organ showing 
fatty degeneration. The stomach and intestines may be di- 
lated, the atrophied mucosa being the seat of a chronic 
catarrh with fibrous interstitial changes. The arteries 
usually show arteriosclerotic changes, frequently associated 
with cardiac dilatation. The superficial capillaries and 
venules, especially of the cheeks and nose, are dilated and 



PATHOLOGY AND BACTERIOLOGY. 331 

have thickened walls (acne rosacea). The kidneys are less 
affected than the organs of the digestive tract, but are often 
enlarged or contracted and show arterio-sclerotic changes. 
The resistance to tuberculosis and other infections is de- 
creased in topers. 

Describe why and how obstructive disease of the cor= 
onary arteries causes myocardial degeneration. 

The coronary arteries are end arteries with only capillary 
anastomoses between their terminal branches, and supply the 
myocardium with nutriment. Therefore unless abnormal 
anastomoses exist or a vicarious compensating flow through the 
vessels of Thebesius and the coronary veins occurs, obstruc- 
tion to the circulation in the coronary arteries results in 
ischemia and degeneration or death of the heart muscle sup- 
plied by the obstructed vessel. A coronary thrombus or em- 
bolus causes a myocardial infarct. A more gradual obstruc- 
tion may lead to a fibrous myocarditis. 

"^ Explain the pathological characteristics respectively of 
exudative and productive renal degeneration. 

In the exudative renal degeneration there is an escape of 
blood serum, leukocytes, at times erythrocytes, and the pro- 
ducts of epithelial cells into the capsules of Bowman, the 
renal tubules, and at times into the intertubular connective 
tissue. In the productive renal degeneration there is a new 
growth of fib ro- connective tissue about the capsules of Bow- 
man, about the blood vessels, and in the capsule proper of 
the kidney. Often there is an association of productive and 
exudative changes in the same organ. 

What varieties of degeneration may occur in lymph 
glands? 

Fatty degeneration, pigmentary infiltration, calcification, 
hyaline degeneration, amyloid degeneration. 
— Mention the malignant neoplasms. 

The varieties of carcinoma, including epithelioma ; sarcoma, 
endothelioma. 



332 PATHOLOGY AND BACTERIOLOGY. 

What tissues are most frequently the seat of tubercular 
formation? 

In order of frequency — lungs, lymph glands, ileum and 
larynx, joints, pleura, meninges, peritoneum, 'bones, spleen, 
kidneys and genito-urinary organs. 

(a) On what principle are tumors classified? (b) Men= 
tion the important classes of tumors, giving an example 
under each class. 

The varieties of normal tissue that they typify. 

1. Adult connective tissue type, as fibroma. 

2. Embryonic connective tissue type, as sarcoma. 

3. More highly specialized tissue type, as myoma, neuroma, 
lymphangioma. 

4. Endothelial type, as endothelioma. 

5. Epithelial type, squamous, columnar or glandular, as 
squamous papilloma, columnar epithelioma, adeno-icarcinoma. 

6. Tumors of mixed type, as teratoma, 

What pathologic changes may result from cerebral 
hemorrhage? 

Cerebral hematoma, softening, cyst, cicatrix, poreneephalus, 
atrophy or sclerosis. Atrophy of voluntary muscles and 
cutaneous tissues, secondary descending sclerosis of motor 
paths. 

Give the process of tubercle development. 

(1) Lodgment of tubercle bacilli, (2) Proliferation of epi- 
thelioid cells and an invasion of lymphoid cells in the affected 
area, (3) Fusion of epithelioid cells with formation of giant 
cells, (4) Central coagulation necrosis, (5) Fusion of adja- 
cent tubercles with caseation, producing yellow tubercle. 

- What is (a) productive inflammation? (b) Suppurative 
inflammation? 

(a) One characterized by the formation of new fibro-con- 
nective tissue. 

(b) One characterized by the formation of pus. 



PATHOLOGY AND BACTERIOLOGY. 333 

What structures are principally involved in bubonic 
plague? How are these structures affected? 

Lymphatic glands — suppurative lymphadenitis ; lungs • — 
a form of bronchopneumonia; intestinal tract — hemorrhagic 
gastro-enteritis ; kidneys — an acute interstitial and parenchy- 
matous nephritis; spleen — hyperplastic splenitis. 

Mention the varieties of eczema. 

Squamous, papular, vesicular, pustular, impetiginous, ec- 
zema parasiticum, rubrum, fissum, impetiginodes, marginatum, 
populosum, vesiculosum, pustulosum, squamosum, sclerosum, 
seborrheieum, ulcerosum. 

What pathologic conditions increase the elimination of 
urea? 

Acute fevers, inflammations, bacterial infections, in dia- 
betes, rheumatism, gout, in lithemia. 

Give the lesions of typhoid fever. 

Catarrhal entero-colitis, infiltration and hyperplasia of 
Peyer's patches, terminating in necrosis and ulceration, hem- 
orrhages, perforation or cicatrization. Mesenteric lympha- 
denitis. Splenic hyperplasia, parenchymatous hepatitis and 
nephritis. At times degeneration of cardiac or voluntary 
muscles, hypostatic congestion of lungs and ulceration of 
larynx occur. 

What pathologic changes take place in the blood 
plasma? 

Hypertonicity (excess of salt) hyperinosis (excess of 
fibrin factors) ; hypinosis — deficiency in fibrin factors; hy- 
dremia (excess of water) ; anhydremia — deficiency in water. 
Lipemia — contains fat droplets ; melanemia — contains mel- 
anin; hemoglobinemia — contains dissolved hemoglobin. Ab- 
normalities in alkalinity. 

What conditions may cause dropsical effusion in the 
abdomen and in the lower extremities? 

Oirhosis, or tumor of the liver, syphilitic hepatitis, valvu- 



334 PATHOLOGY AND BACTERIOLOGY. 

lar heart disease, pulmonary disease, neoplasms, parasites or 
inflammatory exudates interfering with the portal circulation, 
tuberculous peritonitis. 

Give the causes and pathologic anatomy of Iympha= 
denitis. 

Inflammation of lymphatic glands results from irritants, 
especially the pyogenic 'bacteria, the tubercle bacillus and the 
bacillus of plague. The glands are enlarged, hyperemic, soft, 
pulpy, and infiltratd by serum and red and white corpuscles, 
and may suppurate. 

What is calcific metamorphosis? 

The transformation of cells into a calcareous or mineral 
substance. 

Name some of the causes of active hyperemia and give 
illustrations. 

Paralysis of vaso-constrictor or stimulation of vaso-dilator 
nerves, mechanic, thermic or chemic irritation, as shown in 
blushing, after friction of skin, application of heat or cold, 
or action of bacterial or drug irritants. 

Illustrate and define hypostatic inflammation. 

When the circulation is insufficient the blood tends to settle 
or stagnate in dependent parts of the body (hypostatic con- 
gestion), and a form of inflammation may ensue (hypostatic 
inflammation), such as the hypostatic pneumonia occurring 
in low forms of typhoid fever. 

^ What are some of the phenomena attending pus for= 
mation? 

Heat, redness, swelling, tenderness, throbbing pain, soften- 
ing of tissue, fluctuation, pointing. 

Describe the pathologic conditions in hectic fever. 

Hectic fever is a persistent form characterized by high 
exacerbations at night, and resulting from microbic action, 
and, as a rule, the formation of pus within the body. 



PATHOLOGY AND BACTERIOLOGY. 335 

What are pathologic conditions causing favus? 

The proliferation in the hair follicles of a mold, achorion 
schoenleinii. 

How are secretions affected in anemia? 

Usually decreased, although the urine may be increased 
either in hulk or relative solid contents, while the free hydro- 
chloric acid, which may be absent from the gastric secretion 
in progressive anemia, may be present in increased amount 
in chlorosis. 

What organs are most subject to tuberculosis? 

Lungs, lymph glands, serous membranes, bones, spleen, 
kidneys, adrenals, genital organs, bladder, skin. 

Name some of the changes which occur in extravasated 
blood. 

Coagulation, solution, replacement by granulation tissue, 
decomposition and suppuration, desiccation and scabbing. 

What glands are most frequently affected by amyloid 
degeneration? 

Liver, spleen, kidneys, lymph glands. 

To what diseases does calcareous degeneration of the 
arteries predispose? 

Aneurysm, hemiplegia, cerebral softening, dry gangrene. 

"~ Give the varieties of tubercle. 

Reticulated tubercle, lymphoid tubercle, epithelioid tubercle, 
miliary tubercle, submiliary tubercle, gray tubercle, yellow 
or crude tubercle of Laennec. 

(a) What are bacteria? (b) What conditions are favor= 
able to their increase, and (c) what is meant by their toxic 
products? 

(a) Fission fungi or schizomycetes. (b) Warmth, moist- 
ure, albuminous media, usually best if of neutral or slightly 
alkaline reaction, absence of strong actinic rays, (c) Poison- 



336 PATHOLOGY AND BACTERIOLOGY. 

ous substances, toxins, ptomaines or bacterial proiteids formed 
by or in bacteria. 

Name some of the principal bacteria of the staphy!o= 
cocci and the streptococci groups. 

Staphylococcus aureus, staphylococcus albus, staphylococ- 
cus citreus, streptococcus pyogenes, streptococcus erysipelatis. 

Name the important pathogenic diplococci. 

Diplococcus gonorrhoeas, diplococcus pneumonias, diplo- 
coccus meningitidis capsu^itus of Weichselbaum. 

What changes take place in cyanotic atrophy of the 
liver? Give the microscopic appearance of this diseased 
condition. 

A persistent passive' congestion, with secondary hyper- 
plasia of the connective tissue and pigmentation of hepatic 
cells; microscope shows wide dilatation of capillaries and 
veins, with atrophy and pigmentation of hepatic cells and 
overgrowth of perilobular connective tissue. 

Define and illustrate bacilli, micrococci, spirilla. 

(a) Bacilli are rod-shaped; micrococci, (spherical shaped; 
spirilla, spiral-shaped bacteria, (b) Bacillus tuberculosis, 
streptococcus pyogenes, spirillum choleras. 

Give the pathologic features of angioleucitis (lymphan= 
gitis). 

The lymph vessels are inflamed, red, swollen and dis- 
tended by a cell-laden liquid. Their walls are edematous, 
infiltrated by leukocytes, and may be broken down if the pro- 
cess be suppurative. The cause is almost invariably micro- 
organismal, and there is usually an associated lymphadenitis. 

Mention the structural changes that occur in tubercular 
joints. 

Tubercles in the synovial membrane, subsynovial tissue or 
cancellous bone. Diffuse (tumor albus) or nodular (synovitis 
tuberosa) thickening of synovial membrane, or distension of 



PATHOLOGY AND BACTERIOLOGY. 337 

joint with inflammatory serum (hydrops) or puriform liquid 
(empyema) ; erosion of cartilage and hone; tuberculous ab- 
scess and sinus formation. 

Give the possible causes of occlusion of the bile=duct. 

Catarrhal swelling of mucous lining, lodgment of calculus 
or parasitic worm (as ascaris lumbricoides or distoma hepa- 
tinum), invasion by coccidia, cicatricial contraction of walls 
of duct, pressure from without by an adjacent tumor or 
floating kidney, involvement in a neighboring carcinoma, sar- 
coma, endothelioma or an inflammatory process, duodenal 
disease involving the terminal papilla. 

(a) What causes contribute to obesity? (b) What tis= 
sues are most frequently invaded in obesity? 

(a) Anemia, hemorrhages, use of malt liquors, lack of exer- 
cise, hereditary tendency, over-eating, certain dyspesias. 

(b) The subcutaneous tissues and subserous tissues of abdo- 
men, especially about kidneys, in great omentum and appen- 
dices epiploicge. 

In what order are the organs of the thorax and abdo= 
men best examined at a post=mortem section? 

Authorities differ. The following is useful: Inspection of 
abdominal cavity, inspection of pleura, pericardium, heart and 
vessels, examination of heart, lungs, organs of neck, spleen, 
gastro-intestinal tract, liver, pancreas, genito-urinary organs, 
abdominal aorta and sympathetic ganglia. 
22 



SURGERY. 



Define peritonitis. State three ways in which the peri= 
toneum may be invaded by bacteria. 

By peritonitis is meant >an inflammation of the peritoneum. 
Bacteria may invade the peritoneum through the wall of the 
intestine, through a wound in the abdominal wall, or through 
& perforating ulcer of the stomach. 

What is the treatment for stenosis of the lachrymal 
duct? 

Dilatation by means of lachrymal probes. The passage of 
the larger probes is preceded by division of the lower canali- 
culus. If the stenosis is simply due to tumefaction of the 
mucous membrane (as in the new-born) it may yield to 
medicinal agents. 

What are the causes of ischiorectal abscess? 

Infection of the ischio-rectal areolar tissue with pyogenic 
organisms from the perineum or rectum, injuries to the peri- 
neum or rectum, and exposure to cold or wet. Suppuration 
in the ischio-rectal fossa may also be due to disease of adja- 
cent or distant structures (sacro-iliac or hip joints, pelvic 
bones, spine, prostate). 

Give an operation for excision of the tongue for car= 
cinoma. 

Kocher's operation. After all aseptic precautions have 
been carried out, tracheotomy is performed, a well-fitting 
canula is introduced, and the pharynx packed with a carbol- 
ized sponge which has a cord attached to it. The incision 
commences near the lobule of the ear, passes down the ante- 

(339) 



340 SURGERY. 

rior (border of the stenro-mastoid muscle to its middle, along 1 
the hyoid bone to near the median line, and then upwards to 
the symphysis. This flap of skin and subcutaneous tissue is 
dissected up and held out of the way by a retractor. All the 
lymphatic glands in the submaxillary triangle are removed,, 
as well as the submaxillary (and if necessary the sublingual) 
salivary gland, and the facial and lingual arteries are ligated 
close to the carotid. If any portion of the mandible is dis- 
eased it may be removed by enlarging the wound. The oppo- 
site lingual artery is now tied through a separate incision. 
The mylo-hyoid muscle and the reflection of the oral mucous 
membrane are then divided close to the alveolus, the tongue is 
drawn out through the wound and removed close to the epi- 
glottis behind and close to the hyoid bone below. The entire 
raw surface is now painted with Whitehead's varnish, the 
external incision is closed by sutures, excepting the lower- 
most portion, in which a drainage tube is inserted, an aseptic 
dressing is applied, and the sponge in the pharynx is replaced 
by gauze packing. 

How should ankylosis of the jaw be treated? 

By division of the neck of condyle, by excision of condyle, 
removal of the vertical ramus as far as the alveolar border, or 
by the excision of a wedge of bone (apex toward alveolar 
border) from the neighborhood of the angle, and the estab- 
lishment of an artificial joint in this situation (Esmareh's 
operation) . Excision of the condyle and Esmareh's operation 
are the measures usually employed. 

How should hemorrhage from the liver, occurring in the 
course of an operation, be controlled? 

By tamponing with iodoform gauze, by the thermo-eauteryr 
by ligature, and by suture. 

Describe Pott's fracture of the lower extremity. 

By Pott's fracture is meant a fracture of the fibula about 
three inches above the tip of the malleolus. Dependent upon 



SURGERY. 341 

the amount of violence, there may co-exist one or more of the 
following lesions: 1. Rupture of the internal lateral ligament; 
2. Tearing off of the internal malleolus; 3. Fracture of the 
external portion of the articular surface of the tibia. The 
foot is practically always everted, and shows a tendency to 
slip backward. There are points of tenderness over the lines 
of fracture, the foot may be moved from side to side in the 
widened tibio-fibular mortise, and crepitus may be obtained. 

Give the symptoms and treatment of section of the 
median nerve. 

If divided just above the wrist there will be anesthesia over 
the radical side of the palm, over the palmar aspect of the 
thumb, index, middle, and half of the ring fingers, and over 
the dorsal aspect of the terminal phalanges of the same 
fingers. There will be paralysis of the outer group of the 
short muscles of the thumb (abductor, opponens, and outer 
half of flexor brevis pollicis), as a result of which "opposi- 
tion" is impaired, the thumb remaining extended by the side 
of the fingers. The outer lumbricals are also paralyzed, caus- 
ing loss of power of flexion of the index and middle fingers 
at the metaearpo-phalangeal articulation. If divided at the 
bend of the elbow or in the arm, in addition to the previously 
mentioned symptoms, there will be loss of pronation (paralysis 
of flexor carpi radialis) , loss of power in the hand-grasp, par- 
ticularly on the radial side, with probable hyper extension of 
the wrist (paralysis of flexor longus pollicis, of the flexor 
sublines, and of the outer half of the flexor profundus 
digitorum), and paralysis of the palmaris longus. 

Treatment : After all aseptic precautions have been carried 
out, the ends of the nerve are to be sought in the wound and 
approximated by sutures of the finest 'chromicized cat-gut. 
One or more sutures should pass through the nerve and the 
remainder merely through the sheath. A fine Hagedorn 
needle or a domestic sewing-needle without cutting edges 
should be employed. If difficulty is encountered in bringing 
the ends together, the wrist and elbow joints are flexed to a 



342 SURGERY. 

right angle, and subsequently maintained in this position by J 
a fixed dressing. 

State the constitutional effects and give the treatment 
of burns. 

Stage of shock or collapse : The surface of the body is cov- 
ered with a cold and clammy sweat, the temperature is sub- 
normal, the pulse is rapid and feeble, and the respirations, 
are quick and shallow. The tongue is dry, the patient ex- 
periences great thrist, vomiting often occurs, and the urine 
and feces may be passed involuntarily. There is congestion 
of the internal viscera, particularly those in relation with 
the portal system. 

Stage of reaction: Symptoms of septic traumatic fever, 
with special symptoms dependent upon inflammatory affec- 
tions of the internal organs (meningitis, peritonitis, enteritis, 
duodenal ulcer). 

Stage of exhaustion or recovery: Symptoms of septicemia 
or pyemia may make their appearance. Death may occur 
from inflammation of the lungs or pleura or from amyloid 
degeneration of the viscera, If repair is healthy, no abnormal 
constitutional condition follows the second stage excepting 
a certain amount of asthenia. 

Local treatment : Superficial burns without vesication sim- 
ply require a dusting powder such as flour or boric acid. 
If vesication is present, the blisters should be opened aseptic- 
ally, and the part enveloped in lint soaked in carron oil 
(equal parts of linseed oil and lime water, with one part of 
oil of eucalyptus in ten of the mixture), or in aqueous solu- 
tions of picric acid (1-200). In deep burns the part should 
be cleansed as thoroughly as possible, and covered by a 
moist antiseptic dressing until the sloughs separate, when the 
resulting granulating surface may be treated on general prin- 
ciples. During the process of cicatrization, great care must 
be exercised lest 'deformity result from contraction. Such 
deformity may be prevented by the use of splints or weights, 
and particularly by the employment of Thiersch's method of 



SURGERY. 343 

skin-grafting. When a limb has been hopelessly charred it is 
best to amputate in healthy tissue at the earliest favorable 
opportunity. 

Constitutional treatment: Promote reaction by external 
heat, hypodermatic injection of strychnine, and some warm, 
stimulating fluid given by the mouth or rectum. Intravenous 
injection of warm saline solution is advisable in some cases. 
If the pain is severe, opium may be administered. During 
the second stage the secretions should be kept active, and 
the patient placed on a liquid nutritious diet. In the third 
stage, tonics, stimulants, and nutritious easily-digested food 
are indicated. 

Name five of the principal complications of gonorrheal 
urethritis in the male. 

Lymphangitis, bubo, prostatitis, cystitis, and epididymitis. 

What are the indications for exsection of the knee= 
joint? 

Tubercular disease, disorganization of joint after pyemia 
or osteo-arthritis, old, neglected cases of infantile paralysis 
where there is a flail-like limb (Wright), certain cases of 
compound fracture (particularly after gunshot wounds), and 
deformity due to fibrous or bony ankylosis in a bad position. 

What is the treatment of depressed fracture of the 
skull? 

All such cases should be trephined under aseptic pre- 
cautions, and the exact amount of intracranial mischief deter- 
mined. The depressed fragment may then be elevated, and 
any pressure upon the brain immediately relieved. 

Give the indications for the removal of the mammary 
gland. 

Carcinoma, sarcoma, diffuse hypertrophy, diffuse septic or 
tubercular disease, and certain cases of interstitial mastitis. 

What is Paget's disease of the nipple? State the special 
significance of its occurrence. 

Paget 's disease of the nipple is said by some to be a form 



344 SURGERY. 

of eczema, but according to high authority, it is a destructive 
dermatitis of the papillary layer of the skin. It may be due 
to psorosperms, but this is not definitely settled. The nipple 
affected has an excoriated, bright red surface, which dis- 
charges a yellowish viscid fluid. The excoriation spreads 
until the entire areola is involved and the patient complains 
of burning pain. 

The special significance of the occurrence of the disease is 
that it is almost always a precursor of cancer, but this is not 
invariably the case. 

What are the indications for incising the membrana 
tympani? 

The evacuation of serum, mucus or pus from the tympanum, 
the relief of anomalies, of tension of the drum membrane, 
and to gain access to the tympanum for the purpose of re- 
moving intratympanic polypi or dividing synechiae. 

yj Describe the steps in the treatment of a scalp wound. 

Hemorrhage is to be controlled by pressure or ligation. The 
scalp should be shaved for a distance of several inches from 
the margins of the wound. If the wound is very extensive 
the entire scalp should be shaved. All foreign substances are 
removed from the wound, and it is disinfected with antiseptic 
solutions (bichloride 1-1000). The wound should now be 
sutured with silkworm gut and a moist bichloride dressing 
(1-4000) applied. If the wound subsequently shows signs of 
infection, one or more of the sutures should be immediately 
removed, the wound again disinfected, packed with iodoform 
gauze, and allowed to granulate. After granulation has oc- 
curred it may be closed by secondary sutures. Primary suture 
should be the routine treatment in almost every case. 

How can the danger of ankylosis be averted after in= 
jury to a joint? 

By surgical cleanliness, rest, and the early employment of 
massage and passive motion. 



SURGERY. 345 

What are the symptoms of morbus coxae in its different 

stages? 

First stage: Pain in affected joint and corresponding knee, 
limping or shuffling gait, more or less fixation of the joint 
from muscular rigidity, the knee is slightly flexed and the 
limb is usually abducted. Swelling is most marked in the 
arthritic variety of the disease. Heat and redness are usually 
absent on account of the distance of the articulation from 
the surface. 

Second stage : Pain is more acute, the child limps decidedly, 
atrophy of the thigh is apparent, and rigidity of the abductors 
is marked. The limb is somewhat flexed, abducted, everted, 
and apparently lengthened. Flattening of the buttocks is 
present, and the sulcus between the nates is no longer vertical, 
but inclined toward the affected side. Full extension and 
abduction are restricted, "starting" pains are present. 

Third stage : Flexion is marked, adduction is present, and 
shortening is observed which is apparent at first, but sub- 
sequently actual. The whole extremity, including the gluteal 
region, is greatly atrophied. If the diseased leg is extended 
so that the knee touches the table, the lumbar curve becomes 
so pronounced that there is frequently room for the arm of 
the surgeon between it and the table. The rima natium is 
inclined away from the affected side and there is a compen- 
satory double lateral curvature of the spine. Abscesses may 
form and point at the outer side of the thigh below the tro- 
chanter (disease of head of femur), in the pubic region 
(disease of acetabulum), or in the gluteal region (either 
form). If the abscess points above Poupart's ligament, it is 
intrapelvic, if below, extrapelvic. 

What is hydrophobia and how is it treated? 

Hydrophobia is an acute infectious disease resulting from 
the inoculation of a specific virus from an animal suffering 
from rabies. 

Prophylactic treatment: Most important, as no curative 



346 SURGERY. 

treatment exists. The wound, if made by a supposedly rabid 
animal, should be freely excised or thoroughly cauterized 
(actual cautery is best, caustic potash, fuming nitric acid). 
If this canont be done at once, constriction should be applied 
upon the proximal side of the wound. The wound resulting 
from excision should be thoroughly disinfected and sutured 
or treated openly, according to the exigencies of the case. 
Prophylactic inoculations with emulsions of the dried spinal 
cords of rabbits infected with hydrophobia (Pasteur treat- 
ment) should be made in all cases where the animal inflicting 
the bite was rabid, and in those cases in which it can not be 
proven that the animal did not have rabies. The prophy- 
lactic treatment also includes the muzzling of dogs and the 
rigid maintenance of a dog quarantine. 

Palliative treatment: The free use of morphine, chloral 
and ehlorofom. The patient is kept in a darkened room, 
and all external sources of iritation are removed. Nutritive 
enemata may be given. 

How would you perform tracheotomy? 

The patient is placed in the dorsal position, with the head 
extended, and a cylindric cushion placed beneath the neck. 
An assistant holds the head so that the median line of the 
face will correspond to the median line of the neck. After 
all aseptic precautions have been observed and the various 
landmarks (pomum Adami, cricoid cartilage) located, an 
incision, two and a half inches in length, is made in the median 
line, terminating at the lower border of the thyroid cartilage. 
This incision is made from below upward, and divides the 
skin and superficial fascia. The anterior jugular veins lying 
to either side of the median line should be avoided by cutting 
between them and drawing them aside. The deep cervical 
fascia is now divided, the interval between the pretracheal 
muscles recognized, and the wound deepened by blunt dissec- 
tion. The pretracheal fascia is now divided, and the isthmus 
of the thyroid gland drawn downward. After hemorrhage 
has been checked and the tracheal rings clearly exposed, the 



SURGERY. 347 

trachea is steadied by a tenaculum, and two or three rings 
are divided from below upward with a narrow-bladed knife. 
The edges of the tracheal wound are then held apart and the 
tracheal tube inserted. 

What are the symptoms of septic surgical fever? 

There is a sharp rise of temperature 24 or 36 hours after 
the operation or injury. The skin is hot and dry, the pulse 
is rapid, and the tongue is coated. Constipation, anorexia, 
local heat, thirst, restlessness and delirium are present. The 
urine is scanty and highly colored. The lips of the wound are 
red, swollen and tender. The temperature falls with the 
advent of suppuration. 

What are the indications for trephining in fractures of 
the skull? 

All punctured fractures, all compound depressed fractures, 
all simple depressed fractures, and all cases in which there are 
symptoms of intracranial mischief. 

Mention the different kinds of displacement in fracture. 
In what directions does the line of fracture extend in the 
case of the long bones? 

Varieties of displacement: Angular, transverse, longitud- 
inal and rotary. 

Directions of line of fracture: Transverse, oblique, spiral, 
longitudinal, toothed, V-shaped, and T-shaped. 

What general principles govern the diagnosis of a 
tumor? 

The age and. sex of the patient, hereditary influence, the 
history of previous trauma, the location, shape, size, con- 
sistency, and rapidity of growth of the tumor, whether the 
tumor is freely movable or fixed to Ihe surrounding tissues, 
whether it is painful, whether it is encapsulated, whether it 
has given rise to metastases, and whether these have occurred 
through the lymphatics or through the blood-vessels, whether 
the neighboring lymphatic glands are involved, and the pres- 
ence or absence of cachexia. 



348 SURGERY. 

What is the most common seat of rupture of the quad= 
riceps extensor femoris? Give the symptoms and treat= 
ment. 

At its insertion into the patella. 

Symptoms: Sudden pain in the part, inability to extend 
the leg, and the appearance of ecchymosis several days after 
the injury. A swelling may he felt just above the patella 
(extravasation) or a gap may be observed (retraction of 
muscle) . 

Treatment: The treatment usually advised is to place the 
part at rest, the leg being extended on the thigh, and the thigh 
being flexed at the hip. This position tends to bring the 
torn ends together. A certain amount of compression is made 
at the site of the injury, and the extremity is kept in the 
position described until union has occurred. If perfect 
asepsis can be obtained, however, primary suture of the mus- 
cle (if healthy) will give better results. 

What are the steps in the ligation of arteries? 

The preparation of the region in which the vessel is situated 
for an aseptic operation, the incision dividing the skin and 
superfical fascia (at an angle of about five degrees to the 
course of the artery), the division of the deep fascia, the 
recognition of muscular or bony landmarks, and the location 
of the vessel by its pulsations, the opening of the sheath, the 
passage of the aneurysm needle, the tying of the ligature, and 
the closure of the wound. 

Give the treatment for talipes calcaneus. 

Division of the extensor tendons. If the tendo Achillis is 
attenuated, a portion of it may be excised and the ends united 
by suture. In other cases the tendon of a healthy peroneus 
longus may be grafted into the tendo Achillis, or the tubercle 
of the os ©aids, into which the tendo Achillis is inserted, may 
be sawn off and reattached by a peg to the bone at a lower 
level ("Walsham). In the paralytic variety some form of 
apparatus must always be worn. 



SURGERY. 349 

What are the causes and treatment of paraphimosis? 

Causes : Gonorrheal balano-posthitis, ulceration from chan- 
cre or chancroid, violent coitus, and edema following upon 
the retraction of a tight prepuce. 

Treatment: The glans should be rendered bloodless by 
digital pressure or by the compression of a finger bandage 
and well anointed with sweet oil. The index and middle 
fingers of each hand are now crossed behind the glans and an 
attempt made to force the glans through the constricted pre- 
putial orifice by pressing upon it with the thumbs. If the 
edema of the prepuce is very marked, it may be punctured in 
several places to relieve tension. Should this measure fail, 
the preputial orifice (at the bottom of the second groove) is 
to be divided with a sharp-pointed, curved bistoury. Lead 
water and laudanum may then be applied to reduce the in- 
flammatory swelling. 

— In what portion of the base of the skull may fractures 
lead to the escape of cerebro=spinal fluid? 

Cerebro-spinal fluid may escape through the nose in a frac- 
ture of the anterior fossa involving the cribriform plate of 
the ethmoid (if there is a laceration of the mucous membrane 
below the fracture and of the dura and arachnoid above it) ; 
it may escape through the ear in a fracture of the middle 
fossa (if the fracture passes across the internal auditory 
meatus, if the tubular prolongations of the membranes in this 
meatus are torn, if there is a communication between the 
internal ear and the tympanum, and if the membrana tym- 
pani is lacerated). 

Give the symptoms of sacroiliac disease and mention 
the affections from which it must be differentiated. 

Pain and a sensation of weakness in the lower part of the 
back, which is increased by standing, sneezing, or any move- 
ment which suddenly calls the abdominal muscles into play 
and drags on the ilium. The unfortunate individual feels 
as though his pelvis were coming to pieces. The pain is fre- 



350 SURGERY. 

quently referred to the gluteal region or leg (lumbo-sacral 
cord) . If the pelvis is not supported, movements of the lower 
extremity are painful. There is apparent lengthening upon 
the affected side, owing to the tilting downwards and forwards 
of the innominate bone. Lateral compression of the pelvis 
causes pain. The region over the joint is often swollen and 
tender. Abscesses may form, and these may point over the 
articulation, upwards into the lumbar region, forwards into 
the groin, or downwards into the pelvis. Sacro-iliac disease 
must be , differentiated from sciatica, hip-joint disease, and 
lumbar spondylitis. 

Give the differential diagnosis between fracture of the 
neck of the humerus and dislocation of the shoulder joint. 

Fracture. Dislocation. 

Elbow readily approximated to side. Elbow cannot be approximated to 

side without causing great pain. 

Elbow can be made to touch chest Elbow cannot be made to touch chest 
with hand of affected extremity with hand of affected extremity 

upon the sound shoulder. upon the sound shoulder. 

Crepitus. No crepitus. 

Preternatural mobility. More or less fixation. 

Shape of shoulder-joint unchanged. Flattening of shoulder-joint, the head 

of the bone being felt in an ab- 
normal position. 

Deformity recurs after reduction. Deformity does not recur after reduc- 

tion. 

Shortening of the arm. Elongation may be present (sub- 

glenoid), or the arm may be of 
same length as that of opposite 
side. 

What are the indications for thyroidectomy? 

Fibro-adenomatous and cystic goitres, parenchymatous 
goitres which increase in size in spite of palliative treatment, 
and carcinoma and sarcoma of the thyroid gland. 

Describe active congestion, passive congestion. State 
their points of difference. 

Active congestion is an increase in the amount of blood in 



SURGERY. 351 

the more or less dilated arteries of a part, with an increase in 
the velocity of the blood stream. 

Passive congestion is an increase in the amount of blood in 
the more or less dilated veins and capillaries of a part, with a 
diminished velocity of the blood stream. 

In active congestion the part is reddened, not perceptibly 
enlarged, and the velocity of the blood current, the tempera- 
ture and the functional activity of the part are increased. 

In passive congestion the part is bluish, greatly swollen, 
and the velocity of the blood current, the temperature and 
the functional activity of the part are diminished. 

What is the usual site of a vulvovaginal abscess? Give 
the symptoms and treatment. 

In the glands of Bartholin at either side of the entrance of 
the vagina. 

Symptoms : Heat, redness, and tenderness, together with a 
peculiar pyriform swelling. In the early stages this swelling 
is best detected by introducing the finger in the vagina and 
pressing outward against the pubic ramus. 

Treatment: Incision and drainage. The wound should be 
irrigated, packed with iodoform gauze, and made to heal up 
from the bottom. The principles of antisepsis obtain here as 
elsewhere. 

How would you operate for the radical cure of complete 
fistula in ano? 

The bowels should be completely evacuated by a suitable 
purgative, and also by an enema, about an hour before the 
operation. The patient is etherized, placed in the lithotomy 
position, and the perineal and anal regions shaved and prop- 
erly cleansed. The external sphincter is forcibly stretched 
by the thumbs in the rectum, and a grooved director is then 
passed into the external orifice of the fistula, through the 
fistulous tract, and brought out through the internal orifice. 
A curved bistoury is now introduced along the grooved 
director, and all the overlying tissues are divided. All 



352 SURGERY. 

pockets and tributary branches of the fistula must be opened 
up and curetted. All undermined tissue and unhealthy tags 
of skin should be removed. Hemorrhage should be checked, 
the cavity carefully packed with iodoform gauze, and com- 
pression made over the anal region by a thick pad of sterile 
gauze and a T-binder. 

What affections occur on the female external genitalia? 

Vulvitis, vulvovaginal abscess, vulvovaginal cyst, hema- 
toma of vulva, pruritus vulvae, hypertrophy of the clitoris or 
of the nymphas, urethral caruncle, noma pudendi, chancre, 
chancroid, syphilitic ulcerations, venereal warts, papilloma, 
myxoma, and epithelioma. A labial hernia or a hydrocele of 
the round ligament may make its appearance in this situa- 
tion. 

What is the cause of the impulse felt in a scrotal hernia 
on coughing? When is this impulse absent in such a her= 
nia, and in what other condition resembling hernia may it 
be present? 

In a scrotal hernia a portion of the abdominal cavity is, so 
to speak, within the scrotum, and any increase in the intra- 
abdominal pressure will, of course, be transmitted to the 
hernial sac. 

This impulse is absent when strangulation is present. 

An impulse on coughing may be present in a congenital 
hydrocele. 

Differentiate between true and false sacculated aneu= 
rysm. 

The sac of a true sacculated aneurysm contains all of the 
coats of the blood-vessels. In a false sacculated aneurysm 
some of the coats of the blood-vessel are absent. 

Describe the signs of each variety of fistula in ano. 

Complete fistula: There is an external opening in the skin 
and an internal opening in the bowel. 

In complete external fistula : There is an external opening,, 
but no internal opening. 



SURGERY. 353 

In complete internal fistula : There is an internal opening, 
but no external opening. The internal opening may be dis- 
covered by direct inspection through a speculum and some- 
times by palpation. This fistula is often associated with 
undermining of the mucous membrane or with stenosis of the 
bowel. Signs of inflammation may be present and pus may 
be discharged from the rectum. 

Describe the anatomic varieties of abdominal hernia. 

Oblique, or external inguinal : The hernia in all cases enters 
the inguinal canal through the internal abdominal ring, ex- 
ternal to the deep epigastric artery. This variety is called 
complete if it escapes through the external abdominal ring 
(scrotal hernia in the male, labial in the female) ; it is called 
incomplete (bubonocele) if it remains in the inguinal canal. 

Direct, or internal inguinal : The hernia gains entrance to 
the inguinal canal by passing through Hesselbach's triangle 
(bounded by edge of rectus, deep epigastric artery, and Pou- 
part's ligament). It does not pass through the internal 
abdominal ring, and the neck of the hernia is internal to the 
deep epigastric artery. 

Femoral: The hernia passes out of the abdominal cavity 
through the femoral canal and makes its appearance upon the 
thigh. 

Umbilical : The hernia passes through the umbilical ring. 

Obturator: The hernia passes through the obturator canal 
and may make its appearance upon the thigh. 

Sciatic : The hernia passes out of the pelvis through one of 
the sacro-sciatic foramina (usually through the greater) and 
makes its appearance at the lower border of the gluteus maxi- 
mus. The neck of the hernia is above the great sacro-sciatic 
ligament. 

Perineal : All hernias which protrude through the muscular 

floor of the pelvis toward the perineum are designated as 

perineal hernias. The neck of the hernia is below the great 

sacro-sciatic ligament. They receive special names according 

23 



354 SURGERY. 

as to whether the skin, the vagina, or the rectum is pushed 
in advance of the hernial protrusion. 

Inguino-perineal (Coley) : A hernia associated with mal- 
descent of the testis. In these cases the testicle is in the 
perineum and the hernia follows the testicle. 

Diaphragmatic: The hernia protrudes through the dia- 
phragm. Many of these cases are not true hernias, as they 
have no sac of peritoneum. 

Ventral : The hernia appears at any portion of the anterior 
abdominal wall except the umbilicus. They are subdivided 
into epigastric hernia (in the median line above the navel), 
hernia of the linea alba (below the navel) , and lateral ventral 
hernia. 

Lumbar: A hernia making its appearance in the lumbar 
region. It is commonly taught that it passes through Petit 's 
triangle, but no such instance has ever been proved by dis- 
section (Sultan). In some instances it passes through 
Braun's space. 

Internal hernias : 1. Hernia through the foramen of Wins- 
low. 2. Hernia through the duodeno- jejunal recess (retro- 
peritoneal) . 3. Hernia through the retro-ceoal and ileo-cecal 
recesses (retro-peritoneal). 4. Hernia through the inter- 
sigmoid recess (retro-peritoneal). 5. Ketro-vesieal hernia. 
The lateral vesico-umbilical fold is so markedly developed 
that a peritoneal pocket is produced at one side. 
— Describe the symptoms and give the treatment of hem= 
orrhage from the middle meningeal artery. 

Symptoms: The first symptoms are those of concussion. 
These are followed by a temporary return of consciousness 
(very important) and the gradual onset of coma within 24 
hours, usually without any rise in the temperature. Since 
the blood clot presses upon the motor area, localized twitch- 
ings or paralyses may be present. The paralysis is apt to be 
progressive, commencing in the face and then extending to 
the arm and leg. If the clot gravitates toward the base the 
pupil of the same side will be dilated and immobile ; if on the 



SURGERY. 355 

left side aphasia will be present, the pulse will he frequent, 
the respiration slow and stertorous, and the temperature will 
rise to 101° to 103° (or even higher) upon the side opposite 
the clot. 

Treatment: The anterior branch of the middle meningeal 
is the one commonly involved, but the posterior may also be 
the source of the bleeding. After all aseptic precautions 
have been carried out, a semicircular flap is turned down and 
the skull trephined. The pin of the trephine is placed upon 
a point one and one-fourth inches behind the external angular 
process at the level of the upper border of the orbit (anterior 
branch). If the clot is not found the trephine should be 
immediately reapplied just below the parietal eminence at 
the same level as the first opening (posterior branch). The 
clot should now be removed, the trephine opening being en- 
larged with rongeur forceps if necessary, and the cavity 
thoroughly irrigated with sterile water. If the artery is still 
bleeding it should be tied by passing a cat-gut ligature through 
the dura and about the artery by means of a Hagedorn needle. 
Drainage should be provided for and the wound closed in the 
ordinary manner. If there is evidence that the clot is gravi- 
tating toward the base, the first trephine opening should be 
made at a point one-half inch lower than that above given. 

Give symptoms and treatment of fracture of the nasal 
bones. 

Symptoms: Crepitus, deformity (depression or lateral dis- 
placement) , preternatural mobility, swelling, and ecchymosis. 
Severe epistaxis, surgical emphysema, and cerebral symptoms 
are occasionaly encountered. 

Treatment: Reduction at the earliest possible moment in 
order to avoid the persistence of the deformity. It is best 
to give an anesthetic, as these parts are exceedingly sensi- 
tive, and the reduction should be accurate and deliberate. 
The fragment is best returned to its proper position by a 
padded dressing forceps carried well up into the nose and 
assisted by external manipulation. Should there be any 



356 SURGERY. 

tendency toward a recurrence of the displacement the nasal 
chamber should be carefully packed with sterile gauze and 
the packing renewed every 24 hours. 

Describe the steps in the operation of stretching the 
facial nerve. 

After the aseptic precautions have been observed, an inci- 
sion is made commencing behind the pinna opposite the ex- 
ternal auditory meatus and extending downward and forward 
behind the lobule of the ear to the angle of the jaw. This 
incision divides the skin, superficial fascia, superficial layer 
of the deep fascia, and branches of the aurieularis magnus 
nerve. The flaps are now dissected from the parotid gland, 
sterno-mastoid muscle, and mastoid process, care being taken 
to avoid the posterior auricular nerve, vein, and artery. The 
internal jugular vein is close to the posterior margin of the 
wound. After the parotid gland has been separated from 
the mastoid process the trunk of the nerve is found lying on 
the styloid process just above the posterior belly of the digas- 
tric muscle. The nerve is stretched by lifting it up with a 
blunt hook. The external incision is sutured and an anti- 
septic dressing applied. 

How would you expose the brachial artery for ligation 
in the middle of the arm? 

After all aseptic precautions have been observed, an inci- 
sion is made along the inner edge of the biceps muscle. The 
line of the artery is from a point just to the inner side of the 
center of the clavicle to midway between the two condyles. 
The incision divides the skin, superficial fascia, twigs of the 
internal cutaneous nerves, and small branches of the superior 
profunda and anterior circumflex arteries. The deep fascia 
is now divided and the inner edge of the biceps recognized. 
The arm should be held at right angles to the body and not 
allowed to rest upon any support, since the triceps muscle 
would displace the biceps and our muscular guide would be 
lost. The biceps is now displaced outwards and the pulsa- 



SURGERY. 357 

tions of the artery sought for. The median nerve generally 
lies over the artery in this position of the arm. It should be 
drawn inward and the sheath of the vessel opened. 

Give the treatment of foreign bodies in the trachea. 

The performance of a low tracheotomy, a sufficiently exten- 
sive opening being made in the trachea. If the foreign body 
cannot be removed at the time of the operation, by means of 
delicate forceps, coin-catcher, wire loop, or hooked probe, the 
edges of the tracheal wound should be sutured to the cuta- 
neous incision, and the foreign body, if movable, will usually 
be spontaneously expelled. If the foreign body is not ex- 
pelled within a day or two, the trachea and bronchi should 
be examined with a long probe. This excites violent cough- 
ing, which may dislodge the foreign body. The patient may 
be also inverted and simultaneously struck upon the back at 
the level of the tracheal bifurcation (fourth dorsal vertebra) . 

Describe a method of differentiating between (a) the 
urethra, (b) the bladder, and (c) the kidneys as the 
sources of pus in the urine. 

Urethra : It is usually stated that if the urine is passed into 
two beakers, the first quantity will be turbid and the second 
one clear. If the pus originates in the posterior urethra, 
however, it regurgitates into the bladder and both specimens 
will be turbid. (Finger). The urine will usually be acid, 
the pus will be in small quantities, and there will be signs of 
the local inflammation. 

Bladder : The freshly drawn urine will be alkaline, and may 
contain crystals of triple phosphate. The urine is increased 
in amount, and the last portions passed contain ropy, thick 
mucus. It may be possible to identify bladder cells in the 
sediment, and the pus corpuscles are said to be better formed 
than when they originate in the kidney. 

Kidney: In pyonephrosis the discharge of pus may be 
intermittent, clear specimens being obtained for days or even 



358 SURGERY. 

weeks. In calculous and tubercular pyelitis the pyuria is 
usually continuous. The pus is more intimately mixed with 
the urine than when it originates in the bladder or urethra, 
and the urine is acid in reaction. 

In all three instances the history of the case will be of 
value. 

Describe in detail the condition known as talipes equino= 
varus. 

In the ■affection known as talipes equino-varus the heel is 
drawn up and the anterior half of the foot is adducted and 
drawn inwards. The inner border of the sole is concave, and 
traversed by a sulcus corresponding to the position of the 
mid-tarsal joint; the outer border is convex, and this con- 
vexity is usually covered by a bursa. The sole of the foot is 
arched from secondary contraction of the plantar fascia and 
some of the plantar muscles (particularly the abductor hal- 
lucis) , and its center may be marked by a longitudinal crease 
due to a folding over of the outer metatarsal bones. The 
individual walks upon the outer border of the foot, and, in 
neglected cases, even upon the dorsal aspect of the cuboid 
bone. 

In acquired cases the extensor and peroneal muscles are 
paralyzed, and the tibialis anticus, tibialis posticus, flexor 
longus digitorum, and the tendo-Achillis are seeondarly 
shortened. 

The astragalus is displaced forwards and outwards, and is 
the most deformed of all the tarsal bones. The neck of the 
bone is elongated, and the angle between the neck and the 
body, instead of being 35 degrees (child) or 10 degrees 
(adult), is increased to 50 degrees or even more. The sca- 
phoid is pushed to the inner side of the astragalus, the tuber- 
osity approaching or even touching the internal malleolus. 
The ligaments on the inner side of the foot are contracted 
(anterior portion of deltoid), inferior calcaneo-scaphoid, long 
and short plantar ligaments). 



SURGERY. 359 

What means has the surgeon at his command for the 
separation of tissues? 

Knife (scalpel, bistoury, tenotome), scissors, thermo- cau- 
tery, ecraseur, snare, elastic constriction, saw, trephine, 
chisel, osteotome, and the osteoclast. 

Describe talipes equinus and give its treatment. 

In the affection known as talipes equinus the heel is drawn 
up so that the patient walks upon the metatarso-phalangeal 
joints and the toes. The degree of deformity ranges from 
those cases in which there is simply a slight elevation of the 
heel to those in which the foot is almost vertical, and the 
plantar muscles and fascia so contracted that the patient 
walks upon the heads of the metatarsal bones, the toes being 
in a position of hyperextension (or even of hyperflexion). 

Treatment: The milder cases may be treated by means of 
Sayre's apparatus, but subcutaneous division of the tendo- 
Achillis is usually required. The foot is subsequently placed 
in its normal position and put in plaster of Paris. The foot 
is kept in plaster for three months, and a mechanical support 
(rendering extension beyond a right angle impossible) should 
be worn for a year. In severe cases it may be necessary to 
divide the plantar fascia and elongate the tendo-Achillis by 
splicing. In the most obstinates cases some surgeons excise 
the astragalus. 

What are the symptoms of a foreign body in the stom= 
ach? Give the treatment. 

The symptoms of a foreign body in the stomach are fre- 
quently most obscure. There may be a sensation of weight 
and distress, and if the object is rough and irritating there 
may be local tenderness and vomiting of blood-tinged fluid. 
The X-ray will usually furnish valuable aid. 

Treatment : If the foreign body is small, non-irritating, and 
capable of being passed per rectum, the patient should be 
made to eat large quantities of foods leaving a considerable 



360 SURGERY. 

residue. If the foreign body will not pass the pylorus it 
should be removed by gastrectomy. 

What are the causes of acute prostatitis? Describe a 
typical case of acute prostatitis and give the treatment. 

Causes: Urethritis (usually gonorrheal), traumatism, strict- 
ure, retention of decomposing urine, prostatic calculi, and 
cystitis. 

Symptoms : Deep-seated pain, accompanied by a sensation 
of heat and weight in the perineum. The desire to pass water 
is frequent and micturition is painful, particularly at the 
conclusion of the act. Defecation is painful, and digital 
examination per rectum reveals a hot and exquisitely tender 
swelling of the prostate gland. The perineum is also hot and 
tender. The patient cannot sit comfortably, but will support 
his weight upon one buttock to avoid any pressure upon his 
perineum. If suppuration occurs, as is usually the case, the 
pain becomes more marked and of a throbbing character, the 
perineum becomes red and edematous, retention of urine may 
occur, and the passage of a catheter causes excruciating' pain. 
Fever is present, and there may be a marked chill. The 
abscess may discharge through the urethra, rectum, perineum, 
or above Poupart's ligament, 

Treatment : Absolute rest in bed, and a bland, non-irritating 
diet. The bowels should be kept loose to avoid the pressure 
of hardened feces upon the inflamed organ. Hot hip baths 
sometimes cause a marked diminution of the pain. If the 
case is seen early, leeches followed by hot fomentations should 
be applied to the perineum. If the pain is intense, supposi- 
tories of morphine and belladonna should be given. If reten- 
tion is present the urine should be drawn off with a small 
rubber catheter. If suppuration has occurred the passage of 
the catheter will ocasionally rupture the abscess, which may 
then evacuate itself through the urethra. If this does not 
occur, and there are evidences of deep-seated suppuration, 
or if the pus does not discharge freely, the patient should be 
etherized and placed in the lithotomy position. The finger 



SURGERY. 361 

is now introduced into the rectum and an incision made in 
the median line of the perineum down to the seat of pus for- 
mation. The abscess cavity is then evacuated, irrigated, and 
a drainage tube introduced. 

Give the course, symptoms, and treatment of varicocele. 

Course: The affection appears in early adult life (rarely 
after 35), and is practically always upon the left side, vari- 
cocele of the right side alone being almost unheard of. In 
many cases it persists throughout life without any injury to 
the individual, while in some cases it may lead to atrophy of 
the testicle. 

Symptoms : A swelling situated along the spermatic cord 
and feeling like a bunch of earth-worms. The swelling is 
compressible, gives an impulse upon coughing, disappears 
when the patient lies down, and reappears when he stands up, 
even though firm pressure is made over the site of the external 
ring. In most cases the scrotum is relaxed and flabby, and 
there may be a sensation of dragging weight, or even of actual 
pain. The testicle upon the affected side may be smaller or 
flabby, but it is nearly always perfectly healthy. Many indi- 
viduals with this affection worry themselves into a condition 
of mental disquietude out of all proportion to the local dis- 
ease. 

Treatment. Palliative: A well-fitting suspensory bandage. 

Operative : Operative treatment is to be adopted if the 
patient desires to enter the army or navy, if the affection 
causes physical discomfort despite the wearing of a suspen- 
sory, and if the mental condition of the patient cannot be 
relieved until the varicocele is removed. The operation for 
the cure of varicocele consists of the excision of a section of 
the dilated veins. The incision is to be made in the groin, 
and not in the scrotum, as was formerly practiced. About 
two inches of the cord is drawn up through the incision, the 
vas deferens (feels like a "whip-cord") and its accompany- 
ing vessels are carefully isolated and not included in the 



362 SURGERY. 

double ligature ( chromicized cat-gut). The ligatures are 
placed at a distance of from one to two inches from each 
other and the intervening bundle of veins is removed. One 
end of each ligature is cut short, and the other ends are tied 
so that the cord is shortened and the testicle elevated. To 
insure accurate apposition of the two stumps it is well to 
insert one or two sutures of fine cat-gut. All hemorrhage 
must be thoroughly arrested to insure the best results. The 
testicle is now drawn down into the scrotum and the cuta- 
neous incision sutured in the customary manner. 

Describe McBurney's " grid=iron " incision for appen= 
dicitis. What is the advantage of this incision and what 
is the disadvantage? 

After the skin has been carefully disinfected, an oblique 
incision about three inches in length is made, commencing 
one inch above McBurney's line and crossing this line about 
an inch and a half internal to the anterior-superior spine. 
The position of the incision will naturally vary somewhat 
according to the location of the swelling, but it should always 
be made in the direction of the fibres of the external oblique 
muscle. The aponeurosis of the external oblique and a smalJ 
portion of the muscle itself are now divided in the direction 
of the external incision. The fibres of the external oblique 
muscle should be separated (not incised), great care being 
taken that none of the fibres are divided transversely. Re- 
tractors are now placed in the wound and the internal oblique 
and the transversalis muscles are similarly split in the direc- 
tion of their fibres. The transversalis fascia and peritoneum 
are then divided in the usual manner. 

The advantage of the incision is that the abdominal wall is 
not weakened as much as if the muscular fibres were cut 
across, and therefore there is consequently less tendency to 
subsequent ventral hernia. 

The disadvantage of the incision is that the amount of 
room to work in is somewhat lessened, and the performance 
of the operation consequently rendered more difficult. 



SURGERY. 363 

What is the difference between congestion and inflam= 
mation? 

Arterial congestion is an excess of blood in the more or less 
dilated arteries of a part, the velocity of the blood- current 
being increased. The part is reddened, the temperature is 
increased, swelling is scarcely appreciable, pain is not present, 
except that the patient may complain of a throbbing sensa- 
tion, and the function and nutrition of the part are increased. 
If the congestion continues the part becomes either hyper- 
trophied or inflamed. 

"Inflammation is the succession of changes which occur in 
a living tissue when it is injured, provided that the injury is 
not of such a degree as to at once destroy its structure and 
vitality." (Burdon Sanderson). The part is reddened, the 
temperature is increased, swelling may be considerable, and 
pain is present dependent upon the character of the tissue 
involved and the severity of the inflammation. The function 
of the part is diminished and fever is usually present. 

How would you diagnose and treat a case of fracture of 
both bones of the forearm occurring at the middle third? 

The diagnosis is usually apparent at a glance. There will 
be angular deformity, as a rule, crepitus, a new point of 
motion (preternatural mobility), pain, and subsequently 
swelling and ecchymosis. The power of supination and pro- 
nation is entirely lost. In those cases in which the diagnosis 
might be doubtful the X-rays will reveal the nature of the 
lesion. 

Treatment: Reduction by extension and counter- extension 
combined with manipulation at the site of the fracture. 
After the deformity has been reduced the forearm should be 
kept flexed at a right angle to the arm and in a position 
midway between pronation and supination (thumb up!) 
Two splints should be applied, a palmar extending from the 
bend of the elbow to below the wrist. The splints should be 
firmly and evenly padded, and must be broad enough to pre- 
vent circular constriction of the forearm. A primary roller 



364 SURGERY. 

should never be applied, and an interosseous pad is not to be 
employed. Union is usually 'Complete in four or five weeks. 

Define amputation in the continuity and amputation in 
the contiguity of a limb. 

By amputation in the continuity of a limb is meant an 
amputation through the hone or bones of the extremity. 

By an amputation in the contiguity of a limb is meant an 
amputation through any of the joints of the extremity. 

Define the following terms: (a) Bursitis; (b) bunion; 
(c) paronychia. Give the treatment for each disease. 

By bursitis is meant the inflammation of a bursa. 

By a bunion is meant an inflammation of one of the bursa? 
about the foot, usually over the metatarso-phalangeal joint 
of the great toe. 

By paronychia or felon is meant an inflammation of a fin- 
ger. It may be subcuticular, subcutaneous, thecal (suppur- 
ative 'teno-synovitis), or subperiosteal (bone felon). 

Simple acute bursitis is treated by keeping the part at rest 
and the application of fomentations. If the effusion per- 
sists it may be aspirated or the entire cavity may be excised. 
Suppurative bursitis should be treated by early and free 
incision and the subsequent maintenance of effective drain- 
age. Chronic bursitis may be met by rest and counter-irri- 
tation; if these measures fail the bursa should be dissected 
out. Special care must be exercised in dealing with bursa? 
which communicate with a joint. In tuberculous bursitis 
the part should be freely incised, the tubercular tissue 
scraped away, and the cavity packed with iodoform gauze. 

The treatment of bunion is that of acute or of suppurative 
bursitis. If the bone is diseased it must be removed, and any 
malposition of the toe corrected during the period of conva- 
lescence. In some cases the underlying joint must be re- 
sected. 

AH varieties of paronychia are best treated by a free and 
early incision extending well into the inflamed area. In the 



SURGERY. 365 

subcuticular and subcutaneous varieties care must be taken 
not to incise the sheaths of the tendons and thus give rise to 
additional infection. In the subperiosteal whitlow, the inci- 
sion should go down to the bone, and cannot be made too early. 

Describe the various steps in the operation of inguinal 
colostomy. 

After all aseptic precautions have been observed, an inci- 
sion about two inches in length is to be made, one and one- 
half inches above and parallel with the outer portion of 
Poupart's ligament. This incision should be carried down 
to the peritoneum. All hemorrhage having been checked, 
the parietal peritoneum is to be incised for about two-thirds 
the length of the external wound and accurately stitched to 
the skin. While this step of the operation is being performed 
the intestines should be held out of the way by a sterile gauze 
pad. After the colon has 'been found it should be drawn out 
of the wound, pulling from above downward, and returning 
the protruding bowel through the lower angle as it is drawn 
out from the upper one. As soon as the colon is almost taut, 
an opening is made in the meso-sigmoid (or descending meso- 
colon, as the case may be) and a glass rod passed through it 
so as to bring a coil of intestine out of the wound, the ends of 
the rod resting upon the skin. The two limbs of the intes- 
tinal coil are fixed by suturing them together beneath the 
glass rod. An aseptic dressing is now applied. Adhesions 
will be sufficiently firm by the third or fifth day, when the 
intestine may be opened by a transverse incision. This latter 
step may be performed without an anesthetic. A few days 
later all of the bowel projecting above the skin may be cut 
away and the bleeding carefully checked. Should it be neces- 
sary to open the bowel immediately, the intestine should be 
accurately sutured to the lips of the cutaneous incision and 
a Paul 's tube tied in place. 

Describe an operation for wry=neck. 

Open myotomy of the sterno-cleido-mastoid muscle. All 



366 SURGERY. 

aseptic details having been observed, the skin is freely incised 
about a half inch above the clavicle, and the sternocleido- 
mastoid muscle is freely divided at the level of the cutaneous 
incision, the external wound is closed, and an aseptic dressing 
is applied. The faulty position of the head is then over- 
corrected and fixed in its new position by a plaster of Paris 
bandage or other suitable contrivance. 

What are the causes of dysphagia? 

1. Pharyngeal: Acute or chronic inflammation, tubercu- 
losis, syphilis, malignant growths, stricture, paralysis, naso- 
pharyngeal polypi, impaction of foreign bodies, and retro- 
pharyngeal abscess or tumor. 

2. Laryngeal: Acute or chronic inflammation, tuberculosis, 
syphilis, or malignant growths. 

3. Esophageal": Acute or chronic inflammation, impaction 
of foreign bodies, the presence of diverticula, esophagospasm, 
and simple or malignant stricture. 

4. Extrinsic causes: Aneurysm, goitre, enlarged glands, 
mediastinal growths, pericardial effusion, tumors growing 
from the bodies of the vertebra, and backward dislocation of 
the sternal end of the clavicle (modified from Eose and Car- 
less) . 

What are the varieties of arteriovenous aneurysm and 
state their points of difference. 

An arterio-venous aneurysm is either an aneurysmal varix 
or a varicose aneurysm. 

An aneurysmal varix is a direct communication between 
an artery and a vein without the interposition of a sac. 

A varicose aneurysm is an indirect communication between 
an artery and a vein with the interposition of a sac. 

Give the main points of difference between acromegaly, 
ostitis deformans, and leontiasis ossea. 

Acromegaly occurs in young adults (20-30). It affects the 
bones of the hands and feet and those of the face (particu- 



SURGERY. 367 

larly the lower jaw and the nasal bones) . The cranial bones 
are not affected, with the exception of the lower portion of 
the frontal bones and the margins of the orbits. The bones 
of the hands and feet are broader, bnt there is no increase in 
their length. Microscopically the osseous structure does not 
differ from that of normal bone. 

Ostitis deformans begins more commonly in men past mid- 
dle life. It affects the long bones of the extremities and the 
bones of the cranium. The facial skeleton shows little 
change. Kyphosis is present. Pain is present in the early 
stages of the disease, but, unlike other bone pains, it is not 
worse at night. The affected long bones are increased in 
length. The microscope reveals changes similar to those of 
rarefying ostitis. 

Leontiasis ossea begins in early life, and the extremities are 
not affected. Both the facial and the cranial bones are in- 
volved, the bones of the jaws first becoming enlarged. 

Give the treatment for mammary carcinoma. 

The treatment of mammary carcinoma consists of the earli- 
est possible removal of the entire breast, together with the 
axillary and supraclavicular glands. All these structures 
should be removed in one continuous piece, so that no infected 
lmyphatic vessel is divided. Advanced cases may require the 
removal of the sternal portion of the pectoralis major and of 
the pectoralis minor, and in such cases the entire mass re- 
moved should also be in one piece. The sharpest knife ob- 
tainable should be used. The first thought in the mind of the 
surgeon should be to remove all of the cancerous tissue, the 
closure of the wound being a consideration of secondary 
importance. Adequate drainage should be provided, and 
skin grafting should be resorted to if sufficient cutaneous 
covering cannot be safely left to close the wound. Those 
cases are to be regarded as inoperable in which the disease is 
no longer local. Palliative operations may be performed for 
the relief of pain in certain well-selected cases. 



368 SURGERY. 

Describe the various steps in amputation at the wrist 
by a long palmar flap. 

After all aseptic precautions have been observed, the hand 
is supinated, the thumb is abducted, and an incision is made 
commencing: at the styliod process of the radius and extend- 
ing over the thenar eminence to the distal transverse palmar 
crease. This incision is continued transversely across the 
palm and then up over the hypothenar eminence to the styloid 
process of the ulna. This flap is now dissected away from 
the bones, and contains all of the structures of the palm ; the 
flexor tendons and large nerves should be divided at the level 
of the wrist joint and removed. The hand is then placed in 
the pronated position and a slightly curved incision is made 
connecting the two styloid processes, the convexity of the 
incision being directed downward. The extensor tendons 
and the lateral and posterior ligaments of the wrist are 
divided and the hand removed. After all hemorrhage has 
been checked the palmar flap is brought over the ends of the 
bones and held in position by interrupted sutures of silk- 
worm-gut. An aseptic dressing is then applied. 

How does ulceration differ from mortification? 

By ulceration is meant the molecular death of a part; by 
mortification (or gangrene) is meant molar death or the 
death of the part en masse. 

Differentially diagnose phimosis and gonorrhea from 
phimosis and subpreputial chancroid. 

In phimosis and gonorrhea there is no history of a sore on 
the glans or prepuce, the preputial swelling is at first simply 
edematous, the discharge is usually purulent, there is no local- 
ized area of hardness or tenderness, chordee is frequently 
present, the ardor uringe is felt along the entire urethra, 
vesical symptoms are not uncommon, and bubo is very rare. 

In phimosis and subpreputial chancroid there is a history 
of a sore, the preputial swelling is due to plastic exudate 
about the ulcer, the discharge is frequently bloody, a localized 
area of hardness or tenderness is usually present, true chordee 



SURGERY. 369 

never occurs, the ardor urinse is experienced only when the 
urine comes in contact with the ulcerated foreskin, vesical 
symptoms are absent in uncomplicated cases, and bubo is 
common. 

Describe Bassini's operation for the radical cure of ob= 
lique inguinal hernia. 

After all aseptic details have been observed, an incision is 
made parallel to and one-half inch above Poupart's ligament. 
This incision extends from above the center of Poupart's lig- 
ament to the base of the scrotum, and exposes the aponeurosis 
of the external oblique and the external abdominal ring. All 
hemorrhage having been checked, a grooved director is carried 
into the inguinal canal, and the aponeurosis of the external 
oblique is divided to a point well above the internal abdominal 
ring. The upper flap of aponeurosis is freed until the arching 
fibres of the conjoined tendon come into view; the lower flap 
is drawn down until the shelving edge of Poupart's ligament 
is exposed. The sac is now separated from the cord (the cord 
usually being behind the sac) , and this separation is carried 
up to the internal ring. The sac is opened, adhesions prop- 
perly dealt with, omentum ligated in sections, and the intestine 
returned to the abdominal cavity. The sac is then ligated at 
a point high up, just above the internal ring, and the redund- 
ant portion cut off about a centimeter below the ligature. 
The cord is now held up out of the wound by a strip of sterile 
gauze, and the conjoined tendon sutured to the deep shelving 
of Poupart's ligament by four or five sutures. It has been 
advised to place one suture above the cord, as this is the point 
at which the recurrence is most likely to occur. None of these 
sutures should be tied too tightly, as strangulation of the 
tissues greatly favors infection and interferes with primary 
union, which is absolutely essential to the success of the 
operation. The cord is now laid upon its newly-formed bed 
(after resection of some of the veins if necessary), and the cut 
edges of the aponeurosis of the external oblique are united 
by a continuous suture. Great care should be taken to pre- 
24 



370 SURGERY. 

vent any suture interfering; with the circulation in the cord. 
The cutaneous wound is then closed with a subcuticular stitch 
and an aseptic dressing: applied. The deep sutures should 
consist of kangaroo tendon, the superficial ones of chromi- 
cized cat-gut. If the operator is not sure of the asepticity of 
the tendon or cat-gun, silk sutures should be employed. 

Give the differential diagnosis of abscess. 

If an abscess is present there will a history of a preced- 
ing inflammation, fluctuation, a tendency to point, an absence 
of thrill, an absence of bruit, a febrile temperature (as a 
rule) , and an examination of the blood usually reveals a poly- 
morphonuclear leukocytosis. If the abscess lies over a blood- 
vessel it may have an up-and-down pulsation, but if the 
abscess is pushed to one side this pulsation ceases. In such a 
case the abscess will not change in size if pressure is made 
upon the vessel above or below the abscess. The exploring 
syringe reveals pus. 

Aneurysm : If an aneurysm is present there will be no his- 
tory of a preceding inflammation, fluctuation is rare, the 
swelling preserves its fusiform or rounded shape, showing no 
tendency to point, thrill and bruit are present, the pulsation 
is expansile, the swelling cannot be moved from the line of 
the blood-vessel, pressure above the aneurysm decreases its 
size and expansile force, pressure below the aneurysm in- 
creases its size and expansile force, there may be a difference 
in the pulse to the distal side of the aneurysm as compared 
with the corresponding vessel upon the opposite side, and 
leukocytosis and fever are absent ( unless the sac is inflamed). 
The exploring syringe reveals blood. 

Cysts : The overlying tissues are not edematous, nor is there 
a history of a preceding inflammation. The exploring syringe 
is of value in doubtful cases. 

Tumors: The only tumor apt to be confused with an ab- 
scess is a rapidly growing sarcoma (small round cell). Al- 
though these tumors may fluctuate, inflammatory symptoms 
are absent, and the exploring syringe reveals a bloody fluid. 



SURGERY. 371 

Describe intermediate and secondary hemorrhage, giv= 
ing both preventive and curative treatment of each. 

By intermediate hemorrhage is meant a hemorrhage recur- 
ring within twenty-four hours of an accident or operation. 

Preventive treatment: The proper method of tying the 
ligatures (surgeon's knot), which should include the artery 
alone, and not the surrounding tissues. All bleeding points 
should be carefully and completely controlled at the time of 
the accident or injury, and stimulants should not be injudi- 
ciously employed. 

Curative treatment: Elevation and pressure. If these 
measures are not successful, the wound should be opened up, 
irrigated with hot sterile saline solution, and all bleeding 
points tied. If ligatures cannot be applied, the actual cau- 
tery may be employed, or the wound may be packed with 
antiseptic gauze. 

By secondary hemorrhage is meant any hemorrhage occur- 
ring in a wound after the lapse of twenty-four hours from 
the time of the injury or operation. 

Preventive treatment: Thorough asepsis, the proper appli- 
cation of ligatures to all bleeding points, and the avoidance 
of the injudicious use of stimulants. 

Curative treatment : This will depend upon whether the 
hemorrhage comes from the end of a divided artery (as in a 
stump) or whether it comes from an artery which has been 
ligated in its continuity. 

If the hemorrhage comes from the end of a completely 
divided artery (as in a stump), elevation, exposure to the air, 
irrigation with hot sterile saline solution, and firm bandaging 
may suffice in the milder cases. If the hemorrhage recurs, 
the wound must be opened again, and the bleeding points 
ligated. If ligatures cannot be employed on account of the 
septic condition of the tissues, the actual cautery will be of 
service. All septic sloughs should be removed by the Volk- 
mann spoon, and the wound swabbed out with carbolic solu- 
tion (1-20) or with a solution of chloride of zinc (1-12). 
The wound should then be dusted with iodoform crystals. 



372 SURGERY. 

firmly packed with iodoform gauze, and a firm bandage 
applied. If the secondary hemorrhage occurs later in the 
case, the wound must be opened up, the bleeding vessel iso- 
lated from the surrounding structures, and ligated higher up. 
If this is impossible, the artery must be ligated still higher 
up, or a re-amputation performed. If the secondary hemor- 
rhage occurs after a shoulder or hip amputation, proximal 
ligation is the only measure to rely upon should the local 
treatment fail. 

If the hemorrhage comes from an artery which had been 
ligated in its continuity, the same local treatment should be 
adopted as in the former instance. If this is unsuccessful, 
the treatment will depend upon the situation of the vessel. 
If the vessel is in the trunk (iliac) or neck (carotid) the 
wound must be opened up, the artery again ligated above and 
below, and the septic 'Condition of the tissues combated by 
packing with antiseptic gauze. If this fails, and proximal 
ligation is impossible, pressure will be the last resort. In 
the arm, if cold, pressure and elevation are without effect, 
the original wound must be enlarged, and the vessel tied 
above and below. If the hemorrhage still continues, the 
artery must be exposed and ligated higher up through an 
independent incision, or amputation will have to be per- 
formed. In the leg, a second ligature at a higher point is of 
questionable value on account of the poorer collateral circu- 
lation. Should it control the hemorrhage, gangrene will re- 
sult, and consquently amputation should at once be per- 
formed if the local measures are unsuccessful. 

State the differences between sthenic and asthenic in= 
flammatory fever. 

Sthenic inflammatory fever occurs in the young and in the 
robust. It rarely commences with a chill, the temperature 
rises to 102 degrees or 103 degrees F., delirium if present is 
maniacal, the pulse is full and strong, the skin is hot and dry, 
and constipation is present. 

Asthenic inflammatory fever occurs in the aged and in the 
debilitated. It usually commences with a chill, the temper- 



SURGERY. 



373 



atures rises to 104° or 105° F., the delirium is low and mutter- 
ing, the pulse is rapid and weak, the skin is cold and clammy, 
and diarrhea is present. 

Differentiate dislocation of the head of the femur from 
fracture of its neck, and give main essentials of treatment 
of each. 



Dorsdl Dislocation. 

Inversion of foot. 

Immobility. 

Head of femur not felt in its natural 
position. 

The buttocks of the affected side are 
unduly prominent, due to the pres- 
ence of the head of the dislocated 
bone. 

Crepitus is absent. 



Immediate shortening of two or three 
inches. 

Earely occurs after forty-five, and 

more commonly in the male. 
Violence usually considerable. 



Reduction by flexion of le g upon 
thigh (for leverage), flexion of 
thigh upon abdomen (to relax Y- 
ligament), external circumduction, 
and extension. When reduction 
has been effected, the knees should 
be bandaged together, and the pa- 
tient kept in bed for two weeks. 



Intracapsular Fracture. 

Eversion of foot. 

Preternatural mobility. 

Head of femur felt in its natural 
position. 

Flattening of hip, the great trochanter 
moving in an arc of smaller radius, 
and relaxation of the ilio-tibial 
band. 

Crepitus may be elicited (unless im- 
paction is present). 

Immediate shortening of a half-inch, 
consecutive shortening of two or 
three inches, 
and Much more common in advanced life 
and in the female. 

Violence usually trivial. 

Treatment. 

Reduction by extension and counter- 
extension. Buck's extension should 
be permanently employed. A sand- 
bag extending from the axilla to 
the external malleolus should then 
be placed upon the outer side of 
the extremity, and one extending 
from the groin to the internal mal- 
leolus upon the inner side of the 
extremity. 
In some cases it may be advisable to 
apply a plaster cast over the abdo- 
men and over the injured extremity 
to below the knee, and to allow the 
patient to change her position. In 
other cases the general condition of 
the patient makes it imperative to 
absolutely disregard the fracture. 



374 SURGERY. 

Describe a method of amputation of the thigh. 

The method giving the 'best results will generally be a flap 
amputation through the skin and a circular amputation 
through the muscles (mixed method). After all aseptic pre- 
cautions have been observed, and a tourniquet properly ap- 
plied, the surgeon takes his position upon the right side of the 
extremity to be amputated and makes a straight incision upon 
either side of the thigh. These incisions commence at the 
level at which the bone is to be divided ; they iare as long as 
the diameter of the limb at their point of origin, and they 
divide the skin and subcutaneous connective tissue. The 
lower ends of these incisions should be connected by a trans- 
verse cut of similar depth, and the corners of the flap rounded 
off. The centers of the two incisions should now be joined 
by a posterior transverse incision, the corners being rounded 
off as before. The anterior flap is now raised, and consists of 
nothing but skin and subcutaneous fat, excepting at its base, 
where a 'certain amount of muscular tissue should be included. 
The posterior flap is then dissected up, and should consist of 
nothing but skin and subcutaneous fat throughout. The 
muscles are now to be divided by a circular sweep of the knife. 
An assistant retracts the muscular tissue, a cuff of periosteum 
is raised, and the bone is sawn through as high up in the 
wound as possible ( about one and one-half inches above the 
angles of junction of the flaps). After the main vessels have 
been secured the tourniquet should be loosened and all bleed- 
ing points caught and ligated. Large nerves are drawn out 
and divided with scissors at the highest possible level, any 
projecting tendons are retrenched, and capillary hemorrhage 
is checked by hot sterile saline solution. The muscular tissue 
may then be sutured over the end of the bone if desired, and 
the edges of the flap united by interrupted sutures. The 
opration is 'Concluded by the application of an aseptic 
dressing. 

Give the symptoms and treatment of luxation of the 



SURGERY. 375 

elbow=joint with special reference to the prevention of 
ankylosis. 

The most frequent dislocation, that of both bones back- 
ward will be selected. 

Symptoms : The elbow is flexed, the forearm is midway be- 
tween pronation and supination, and slight motion causes great 
pain. The olecranon and the head of the radius may be felt 
posteriorly while the lower extremity of the humerus is 
prominent anteriorly. The forearm is shortened and the 
olecranon projects above a line connecting the two condyles. 

Treatment : The patient is seated in a c^air. The surgeon 
places his knee in the bend of the elbow and makes pressure 
against the lower end of the humerus, simultaneously fixing 
the forearm by grasping it just above the wrist. After 
maintaining this pressure for a short time the forearm is 
slowly but forcibly flexed upon the arm, the knee of the 
surgeon acting as a fulcrum and disengaging the coronoid 
process of the ulna from the trochlear surface of the hu- 
merus. The elbow is then put upon an angular splint or en- 
cased in a plaster of Paris bandage for two weeks after 
which passive motion and massage should be employed daily 
to prevent ankylosis. A lighter splint should be worn be- 
tween the periods of massage for at least one week longer. 

Outline the treatment for irreducible umbilical hernia. 

If any contra-indication to operation exists and there is no 
risk of strangulation some retentive apparatus may be worn. 

Practically all of these teases, however, should be operated. 
The entire hernial site is excised, the contents are reduced, and 
the abdominal wound is closed layer by layer. The patient 
should be kept upon her back until the union is firm and 
an abdominal belt may be worn for several months. 

Describe the operation of perineal prostatectomy. 

After all aseptic precautions have been carried out the 
patient is placed in the lithotomy position and an inverted 
V-shaped incision is made through the skin and superficial 



376 SURGERY. 

fascia, the apex of the V being over the posterior part of 
the bulb and the branches extending to a point midway be- 
tween the anus and the tuberosity of the ischium. The central 
tendon of the perineum and the recto-urethralis muscle are 
divided so that the rectum may easily be retracted backward 
giving free access to the membranous urethra and the apex 
of the prostate gland. The membranous urethra is incised 
longitudinally upon a grooved staff, the edges are caught with 
forceps and Young's prostatic tractor is introduced and 
opened out. By pulling upon the tractor the prostate is 
brought well down into the wound and may be readily 
enucleated. By making two divergent incisions into the pros- 
tate as advised by Young, the ejaeulatory ducts, and the floor 
of the urethra may be spared. If a median bar or lobe be 
present it may be made to project into one of the laterai 
cavities and also enucleated. In some cases the finger may be 
substituted for the prostatic tractor with advantage. 

Describe any one of the dislocations of the shoulder= 
joint. 

Subcoracoid dislocation. There is a flattening of the 
shoulder- joint, the head of the humerus being felt beneath the 
coracoid process. The vertical circumference around the 
axilla is increased (Callaway's sign). A ruler or straight- 
edge may be brought in eontact with the tip of the acromion 
and the external condyle of the humerus simultaneously 
(Hamilton's sign) . If the hand of the dislocated extremity be 
placed upon the sound shoulder the elbow cannot be approxi- 
mated to the chest- wall (Dugas' sign). The elbow is away 
from the side and slightly posterior. The axis of the arm is 
altered. The patient is unable to touch the top of his head 
with the hand of the dislocated extremity. 

Give the diagnostic symptoms and the surgical treat= 
ment of congenital inguinal hernia. 

Symptoms : The sudden appearance of an inguinal swelling 
which soon extends into the scrotum. This swelling gives 



SURGERY. 377 

an impulse on coughing and when reduced flops back with a 
gurgle. It is not translucent. The hernia is always of the 
indirect variety. The hernial contents can not be differenti- 
ated from the testicle as readily as in a hernia of the ac- 
quired type. In a congenital inguinal hernia, the testicle is 
at the bottom of the scrotum while in the acquired variety the 
testicle is on the posterior wall of the scrotum at the junction 
of the middle with the lower third. As in the acquired 
variety, the symptoms will also depend upon the nature of 
the hernial contents. A "congenital hernia" may develop at 
any period of life, it is only the sac which is present at birth. 
Surgical treatment: Bassini's operation (described else- 
where). Instead of removing the entire sac as in a typical 
Bassini, a tunica vaginalis is fashioned from its lower por- 
tion. The upper portion of the sac is ligated or sutured as in 
the ordinary operation for the radical cure of the acquired 
variety of inguinal hernia. 

Give the symptoms and treatment of acute ischiorectal 
abscess. 

Symptoms : Severe stabbing pain at one side of the rectum 
which is increased by defecation and digital examination. 
The patient is unable to sit squarely upon the buttocks but 
rests upon the healthy side allowing the inflamed area to pro- 
ject beyond the edge of the chair. Inspection reveals a 
hard brawny swelling at the side of the anus, which is ex- 
quistely tender ; the overlying skin is reddened and edematous. 
The swelling soon softens and exhibits fluctuation upon pal- 
pation. A considerable amount of fever is usually present. 

Treatment : Free incision and the maintenance of gauze 
drainage so that the cavity will heal up from the bottom. 

Give symptoms and treatment of gun=shot and stab= 
wounds of the abdominal wall involving the intestines. 

Symptoms : The presence of a wound of entrance and pos- 
sibly also one of exit. The most characteristic symptoms of 
a wound of the intestine are localized pain and rigidity of the 



378 SURGERY. 

overlying muscles. The other symptoms are so variable that 
small dependence may be placed upon them. Shock may or 
may not be present. 

Treatment: While a masterly inactivity may be justifiable 
in military practice, there is but one course for a competent 
abdominal surgeon to pursue when he can give his patient the 
advantages of thorough asepsis. After all aseptic precau- 
tions have been insured, the wound of entrance should be en- 
larged though it is usually best to make a median incision of 
sufficient length to allow the operator to quickly inspect the 
entire length of the intestinal tract. The small intestine 
should be followed from one end to the other, the assistant 
replacing the bowel as soon as the surgeon finishes his ex- 
amination so that only a single coil is exposed at any one 
time. The large intestine is then to be quickly but thoroughly 
examined. The possibility of an extraperitoneal wound 
should 'also be remembered. All perforation should be 
quickly closed by Lembert or purse-string sutures. If sev- 
eral perforations are close together, time may be gained by 
resecting the gut and making an end-to-end anastomosis by 
means of a Murphy button. If more than half of the lumen 
would be encroached upon by repairing a perforation, resec- 
tion is advisable. If these cases are operated upon early 
(within four hours) irrigation is not necessary. If extravasa- 
tion has occurred, however, the peritoneal cavity must be 
thoroughly irrigated with a large quantity of normal saline 
solution. Drainage may or may not be necessary. Thorough- 
ness! and rapidity are indispensable to the success of the 
operation. 

Give the symptoms and treatment of fracture of the 
base of the skull. 

The general symptoms may be those of concussion, com- 
pression or laceration of the brain. 

The local symptoms will depend upon the cerebral fossa 
involved. 

In the anterior fossa, if the orbital plate be involved, there 



SURGERY. 379 

will 'be subconjunctival ecchymosis and possibly a certain de- 
gree of proptosis as the eyeball may be pushed forward by 
retrobulbar hemorrhage. If the cribriform plate of the eth- 
moid be involved, blood and cerebrospinal fluid will escape 
from the nose. Loss of smell may be present. 

In the middle fossa those signs will be present which are 
described upon page 409. 

In the posterior fossa the symptoms are ill denned. There 
may be bleeding from the mouth or the blood may be swal- 
lowed and subsequently vomited. Deep-seated ecchymosds 
may become manifest among the muscles at the back of the 
neck. The cranial nerves are rarely involved. 

Treatment : Absolute rest in bed. Perfect quiet, the exclu- 
sion of light and sound, a restricted diet and the administra- 
tion of a brisk mercurial purge. The external auditory 
meatus should be thoroughly disinfected, plugged with anti- 
septic gauze, and further protected by an antiseptic pad over 
the ear of the affected side. The nares and throat should be 
kept as clean as possible by the use of an antiseptic spray. 

Describe the varieties and the treatment of fractures 
of the patella. 

The ordinary fracture of the patella is due to muscular ac- 
tion. It is transverse, almost always complete, and the frag- 
ments are usually distinctly separated. 

The safest method of treatment is to fix the knee-joint, re- 
duce the intra-articular effusion by evaporating lotions, pres- 
sure, or aspiration and then to hold the fragments in position 
by the use of Agnew's posterior splint, adhesive plaster, and 
bandages. This treatment can effect only a fibrous union. 

The only way in which a perfect result may be secured is 
by making a free longitudinal incision over the fracture, re- 
moving the clots and fibrous tissue from between the ends of 
the fragments, drilling the fragments obliquely, and wiring 
them together. If rigid asepsis is not secured the patient 
may lose his leg or even his life. This is the treatment to be 
adopted in young active patients whose livelihood depends 



380 SURGERY. 

upon a perfect functional result. If the patient be past middle 
age and of sedentary habits the treatment with the posterior 
splint and the resulting fibrous union may be perfectly satis- 
factory to him if he does not care to assume the risk of the 
operative procedure. 

The second and rarer variety of fracture of the patella is 
that due to direct violence. It is usually stellate but may be 
oblique, longitudinal, or even transverse. It is frequently in- 
complete and the fibrous expansion of the quadriceps may not 
be torn, so that the fragments are not displaced. The over- 
lying tissues are bruised and swollen. 

The posterior splint and evaporating lotions usually give 
good results in these cases. They are not so favorable for 
operation on account of the -contusion of the overlying 
tissues. It is exceptional that operation is required for a 
fracture of this type. 

Describe the treatment for fracture of the shaft of the 
femur at the middle third. 

These fractures are to be treated with a long external splint 
provided with a foot piece (Desault's) , by three shorter splints 
applied to the circumference of the thigh, and by extension. 
The bed should be hard and firm. The foot is firmly ban- 
daged to the foot-piece by a figure-8 bandage, all bony 
prominences being carefully padded. The short splints are 
then applied to the anterior, inner and posterior aspects of the 
thigh and should extend to the knee-joint or slightly beyond 
it. They are to be held in position by two broad pieces of 
elastic webbing. An assistant now makes traction upon the 
splint until the deformity is reduced and the extremity is of 
the same length as its fellow. The pieces of webbing are 
then tightened and secured, and the upper portion of the 
splint is fixed to the body of the patient, preferably by a 
broad piece of muslin which is sewn to the splint, passed be- 
neath the body of the patient and then brought back to the 
splint where it is secured. This broad piece of muslin pre- 
vents anterior displacement of the splint. In addition to 



SURGERY. 381 

this, most surgeons prefer to make permanent extension, the 
stirrup for which is applied before the extremity is fixed upon 
the external splint. Union should be secured in about eight 
weeks but no weight should be born upon the extremity until 
the end of the twelfth week. 

Describe a cartilaginous tumor. Where are such 
growths most commonly found? 

A cartilaginous tumor (chondroma) is a tumor composed 
of hyaline cartilage. They are most commonly found in con- 
nection with some of the long bones, particularly the meta- 
carpal bones and phalanges of the hand, the humerus, the 
tibia, the femur, and rarely the ribs. They may also occur 
in the parotid gland, testicles, breast, or thyroid gland, but 
in these situations they are usually associated with some other 
variety of tumor. 

Mention the inflammatory diseases of bone. 

Periostitis, ostitis, and osteomyelitis. 

What is inflammation? How does inflammation extend 
and how may it terminate? 

"Inflammation is the succession of changes which occur in 
a living tissue when it is injured, provided that the injury is 
not of such a degree as to at once destroy its structure and 
vitality." (Bur don Sanderson.) 

Inflammation may extend by continuity, by contiguity, 
through the blood vessels, and through the lymphatics. 

Inflammation may terminate by resolution, retrogression, 
suppuration, ulceration, or gangrene. 

State the distinction between the antiseptic and aseptic 
wound treatment. 

In antiseptic wound treatment an effort is made to destroy 
the germs in a wound, as well as to prevent the entrance of 
more bacteria. The greatest reliance is placed upon chemical 
agents. 

In aseptic wound treatment an effort is made to prevent the 



382 SURGERY. 

entrance of germs into a wound. The greatest reliance is 
placed upon mechanical purification and upon sterilization 
by heat. 

Mention the general characteristics of a benign tumor 
as distinguished from a malignant tumor. 

Benign tumors, in contradistinction to malignant tumors, 
are usually encapsulated, grow slowly, do not infiltrate, are 
not painful (except by pressure) , do not give metastasis, do 
not recur upon removal, produce no cachexia, and do not cause 
death (except by location). 

What are the indications for ligature of the lingual 
artery? Give the steps of the operation, omitting aseptic 
details. 

The lingual artery is most frequently tied as a preliminary 
procedure to removal of the tongue. Other indications for 
its ligation are to control hemorrhage from the artery or its 
branches, to check the growth of advanced carcinoma of the 
tongue, and certain cases of macroglossia. 

The patient should be on his back, his shoulders raised, and 
his head extended and turned to the opposite side. Starting 
just below the symphysis of the chin, an incision is made 
which passes downward and outward to the greater cornu of 
the hyoid bone, and then upward to the angle of the jaw, 
ending at about the level of commencement of the incision, 
but not endangering the facial artery. This incision divides 
the integument, both layers of the superficial fascia with the 
enclosed platysma, and exposes a portion of the submaxillary 
gland. The deep fascia covering the submaxillary gland is 
now incised and the gland loosened and held up by a retractor. 
We have now exposed Lesser 's triangle, formed by the hypo- 
glossal nerve above and the two bellies of the digastric muscle 
below. The floor of this triangle is formed by the hyoglossus 
muscle. The stylo-hyoid and the tendon of the digastric are 
now drawn downward, the lingual vein and the hypoglossal 
nerve are drawn upward, and an incision is carefully made 



SURGERY. 383 

through the hyoglossus muscle just above the hyoid bone. In 
making this last incision, which exposes the artery, care must 
be taken to avoid wounding the middle constrictor and con- 
sequently opening the pharynx. The submaxillary gland 
and its duct must also be protected from injury lest a salivary 
fistula result. The aneurism needle is now passed about the 
artery, the ligature tied, the external wound sutured, and an 
aseptic dressing applied. The artery may also be secured 
before it passes beneath the hyoglossus, and the danger of 
opening the pharynx is thus greatly lessened. 

Name the different varieties of malignant tumors. 

Sarcoma (round, spindle, and giant-cell, melanotic, alve- 
olar, lympho-sarcoma, and endothelioma) and carcinoma 
(epithelioma, scirrhus, encephaloid, melanotic, and colloid) . 

What are the chief affections of the scrotum? 

Intertrigo, eczema, erysipelas, ecchymosis, edema, chancre, 
chancroid, syphilitic eruptions, tubercular ulceration, ele- 
phantiasis (lymph-scrotum), urinary fistula, tubercular si- 
nuses, gangrene, lipoma, sebaceous cyst, and epithelioma. 

What other methods beside the use of the knife are 
employed to remove a carcinoma from superficial sur= 
faces? 

Caustics and the X-rays. 

Name the principal operations for stone in the bladder. 

Perineal lithotomy, supra-pubic lithotomy, and litholapaxy. 
Name the different varieties of benign tumors. 

Lipoma, fibroma, chondroma, osteoma, glioma, myxoma, 
angioma, lymphangioma, myoma, neuroma, adenoma, and 
papilloma. 

Relate the causes of intestinal obstruction. 

Acute obstruction : 1. Strangulation by bands, adhesions 
or apertures; 2. Volvulus; 3. Impaction of foreign bodies; 
4. Kinking of the gut (rare) ; 5. Acute intussusception; 6. 
The termination of a chronic obstruction. 



384 SURGERY. 

Chronic obstruction : 1. Impaction of feces, gall-stones, for- 
eign bodies ; 2. Intestinal affections, such as stricture, tumors, 
angulation of the gut from contraction of adhesions, matting 
together of intestinal coils; 3. Compression of the intestine 
by tumors or exudates outside of the bowel. 

Describe the ligation of the femoral artery at any 
selected point. 

Ligation at the apex of Scarpa's triangle. The line of the 
artery is from a point midway between the anterior superior 
spine of the ilium and the symphysis pubis to the adductor 
tubercle on the inner condyle of the femur. The patient 
should be on his back, with the thigh abducted, rotated out- 
ward, and slightly flexed. After all aseptic details have been 
carried out, an incision is commenced three inches below Pou- 
part's ligament and carried downward for about three inches 
in the line of the artery, dividing the skin, superficial fascia, 
and fascia lata. If the lymphatic glands are exposed they 
may be held to one side or removed. In making the incision 
the internal saphenous vein should not be wounded. The 
sartorius muscle should now be located, and beneath this mus- 
cle the artery will be found. Remember that the fibers of the 
sartorius run downward and inward, while those of the 
adductor longus run downward and outward. The sheath 
should be opened upon the outer side and the crural branch 
of the geni to- crural nerve and the long saphenous nerve 
avoided. The aneurysm needle is to be passed from within 
outward. The cutaneous wound is then sutured and asep- 
tic dressing applied. 

What are the chief surgical diseases of the groin? 

Inguinal hernia, femoral hernia, lymphadenitis, and en- 
cysted hydrocele of the cord. Psoas abscess, hip disease, and 
pelvic abscess may give rise to swellings, which are first 
observed in the groin. 

How are wounds classified? 

Incised, lacerated, contused, punctured, poisoned, and gun- 



SURGERY. 385 

shot. They may also be divided into septic and aseptic. 
Wounds in the vicinity of great serous cavities are divided 
into penetrating and non-penetrating. Wounds are also 
spoken of as being either subcutaneous or open. 

Describe the anastomosis which takes place after Iiga= 
tion of the femoral artery at its middle third. 

The profunda femoris anastomoses with the articular 
branches of the popliteal and with the tibial recurrent; the 
comes nervi ischiadici anastomoses with the perforating 
branches of the profunda femoris and with the articular 
branches of the popliteal and tibial recurrent. 

Where should the opening be made in order to reach the 
antrum in a case of abscess of the middle ear? 

In the posterior superior angle of the suprameatal triangle 
of Macewen, which is bounded above by the posterior root of 
the zygoma, in front by the upper and posterior segment of 
the osseous external meatus, and behind by a line drawn tan- 
gent to the bony meatus and almost at right angles to the 
posterior root of the zygoma. The chisel is to be directed 
slightly forward to avoid wounding the sigmoid sinus, and 
care should be taken to avoid injury to the facial nerve. 

What agents are employed for the production of local 
anesthesia? 

Ice and salt, carbolic acid, ethyl chloride, cocaine (intra- 
dermic, infiltration, perineural and paraneural methods), 
eucaine, and nirvanin. 

What are the causes of secondary hemorrhage? 

Chief cause: Septic arteritis. 

Contributory causes: 1. Early absorption of ligature; 2. 
Faulty application of ligature ; 3. Ligature too near a col- 
lateral branch; 4. A diseased condition of the arterial wall; 
5. A state of the blood unfavorable to wound repair (albu- 
minuria or diabetes) ; 6. Increased blood pressure (plethora, 
25 



386 SURGERY. 

B right's disease, fever, excitement, injudicious administra- 
tion of stimulants). 

What are the causes of esophageal stricture? 

Gongenital narrowing, the cicatricial contraction of healed 
ulcers ( due to the ingestion of corrosive liquids or to syphilis) , 
carcinoma, polypoid tumors projecting from the mucosa, and 
external pressure (aneurism, goitre, sarcoma of glands or of 
vertebrae, pericardial effusion). Strictures near the cardiac 
orifice may arise from the healing and contraction of a gastric 
ulcer. 

At what point is paracentesis thoracis preferably per= 
formed? 

At the most dependent point of the effusion. The site 
usually selected is in the seventh or eighth interspace just 
below the angle of the scapula or in the posterior axillary line. 

What are the predisposing and what are the exciting 
causes of abdominal hernia? 

Predisposing causes: Early life, male sex, occupations de- 
manding great muscular exertion, structural defects (elonga- 
tion of the mesentery, a patent funicular process), heredity, 
relaxation of the abdominal wall from disease, weakening 
certain portions of the abdominal wall by injury or operation, 
phimosis, pertussis, bronchitis, urethral stricture and consti- 
pation. 

Exciting cause : Any increase of the intra-abdominal pres- 
sure. 

What are angiomata? 

Angiomata are tumors composed of blood vessels, some of 
which are of new formation. 

Define volvulus and give its treatment. 

By volvulus is meant a twisting of the gut in such a manner 
that the intestinal lumen is occluded and the circulation of 
the bowel affected. Treatment : Celiotomy. An attempt may 
be made to untwist the intestine, but this is usually impos- 



SURGERY. 387 

sible. If the attempt succeeds a recurrence of the condition 
should be guarded against by shortening the mesentery. If 
the attempt fails one of three courses may be pursued : 

1. An anastomosis may be performed between * the bowel 
above and that below the volvulus. 

2. Resection of the portion of intestine involved, followed 
by eircular enterorrhaphy. 

3. The making of an artificial anus. If the large intestine 
is involved, as is usually the case, the latter course is prob- 
ably the best one. 

What is an abscess? 

An abscess is a circumscribed collection of pus in a cavity 
of abnormal formation. 

How does a carbuncle differ from a furuncle? 

A carbuncle is a gangrenous inflammation commencing in 
the subcutaneous tissues and extending to the skin. Car- 
buncles are usually single, occur most commonly after middle 
life, show a predilection for the back of the neck or inter- 
scapular region, and discharge through more than one open- 
ing. They are larger, flatter, and accompanied by greater 
constitutional disturbances than are furuncles. 

A furuncle is a gangrenous inflammation commencing in 
the skin and extending to the subcutaneous tissues. Fur- 
uncles are usually multiple, occur most commonly during 
adolescence and early adult life, show no predilection for any 
portion of the body, and discharge through a single centra] 
opening. They are smaller, more conical, and accompanied 
by less constitutional disturbance than are carbuncles. 

What anesthetic would you select for an operation 
about the mouth? 

Chloroform, unless contra-indicated. 

What is an adenoma? 

An adenoma is a tumor, the minute structure of which re- 
sembles that of a gland. Unlike normal glands, these tumors 
have no secretory ducts and no physiologic function. 



388 SURGERY. 

Through what channels is carcinoma disseminated? 

Through the lymphatic channels. 

Describe a dissecting aneurysm. 

A dissecting aneurysm is one in which the blood breaks, 
through an atheromatous ulcer in the intima and burrows its 
way through the substance of the media ; the sac of the aneu- 
rysm is formed within the wall of the vessel. 

What are the varieties of hydrocele? 

Hydroceles of the cord : 1. Diffuse ; 2. Encysted. 

Hydroceles of the testicle: 1. Vaginal; 2. Congenital; 3. 
Infantile; 4. Hydrocele of the funicular process (lower por- 
tion) ; 4. Encysted; 6. Hydrocele of a hernial sac. 

Enumerate the diagnostic points in intussusception. 

Colicky abdominal pain, vomiting, tenesmus, the passage 
of blood-stained mucus or pure blood, and the presence of a 
sausage-shaped tumor, which usually is situated in the line 
of the colon, an absence of resistance being observed in the 
iliac fossa. In advanced cases rectal examination may reveal 
the presence of the intussusception. Acute intussusception 
is more common in early childhood; chronic intussusception 
is more frequently observed in adults. 

What structures are divided in the operation for stran- 
gulated femoral hernia? 

Skin, superficial layer of superficial fascia, cribriform fas- 
cia, femoral sheath, septum crurale, subserous areolar tissue, 
parietal peritoneum, and the seat of constriction, which is 
practically always the lunated edge of Gimbernat's ligament. 
The superficial external pudic artery is always cut and the 
superficial epigastric is usually divided. 

With what conditions may aneurysm be confounded? 

Abscesses, tumors and cysts which are situated near a blood- 
vessel, and pulsating tumors of bone. 



SURGERY. 389 

Where is the swelling and fluctuation most prominent 
In synovitis of the ankle joint? 

At both sides of the tendo Achillis and in front of both 
malleoli (between the external malleolus and the extensor 
communis digitorum tendons and between the internal mal- 
leolus and the tibialis anticus tendon) . 

Give a classification, either original or from competent 
authority, of burns. 

Dupuytren's classification is the best. He divided all burns 
into six classes or degrees: 1. Superficial burns followed by 
redness and desquamation of the epidermis; 2. Burns fol- 
lowed by the formation of vesicles or bullae; 3. Burns de- 
stroying the cuticle and a portion of the true skin ; 4. Burns 
extending into the subcutaneous areolar tissue; 5. Burns 
involving deeper structures, such as muscles and tendons; 6. 
Burns involving all of the constituents of the part. 

Define an acute and a chronic abscess. 

An acute abscess is one which develops with all the signs 
and symptoms of inflammation. It contains pus. 

A chronic abscess is one which is formed without the signs 
and symptoms of inflammation. As a rule they are tuber- 
cular, and do not contain true pus unless a mixed infection 
has occurred. 

Mention the causes of dislocation. Give the cardinal 
symptoms of dislocation. 

Predisposing causes: 1. The anatomic peculiarities of the 
joint; 2. The situation of the joint; 3. Active adult life; 4. 
The male sex. 

Exciting causes: 1. External violence (direct or indirect) ; 
2. Muscular action. 

Symptoms : 1. An alteration in the shape of the joint, the 
displaced articular extremity being frequently felt in an 
abnormal position; 2. An alteration in the length of the 
affected member (shortening or elongation) ; 3. More or less 



390 SURGERY. 

immobility of the affected joint ; 4. An alteration in the direc- 
tion of the axis of the extremity. 

Dislocations, like fractures, are usually accompanied by 
pain, swelling and ecchymosis. 

How are amputations classified in regard to time of 
operating? What period is most favorable for operation? 

Primary; the amputation is performed before the develop- 
ment of inflammation. 

Intermediate; the amputation is performed during the ex- 
istence of active inflammation. 

Secondary; the amputation is performed after the subsi- 
dence of the inflammatory phenomena. 

The primary period is the one most favorable for operation. 

Under what circumstances should an artery be ligated 
in its continuity? What instruments are required for the 
operation? 

An artery should be ligated in its continuity to check 
hemorrhage, to promote the cure of an aneurysm, to diminish 
the rate of growth of a tumor, to reduce the blood supply of 
an organ, and as a preliminary step to the removal of some 
vascular structure (such as the tongue). The instruments re- 
quired are a scalpel, dissecting forceps, retractors, a grooved 
director, several hemostats, an aneurysm needle, ligatures, 
needles, and sutures. 

What are the causes of stricture of the rectum? 

Congenital malformation, syphilis, carcinoma, dysentery, 
tuberculosis, gonorrhea, traumatism or operations involving 
the greater portion of the circumference of the bowel, repeated 
attacks of inflamed hemorrhoids, chronic proctitis, inflamma- 
tory thickening outside of the gut, as in cases of pelvic 
cellulitis after labor, and tumors pressing upon the rectum 
and narrowing its lumen. 

Define nephrorrhaphy, nephrotomy, nephrectomy. Give 
an indication for the performance of each. 

By nephrorrhaphy is meant the stitching of a kidney to the 
posterior wall of the abdomen. Indication, floating kidney. 



SURGERY. 391 

By nephrotomy is meant the cutting into kidney. Indi- 
cation, renal calculus. 

By nephrectomy is meant the excision of a kidney. Indi- 
cation, a primary malignant renal growth. 

Name the methods of inflating the tympanum. 

Valsalva's, Politzer's, and by means of the Eustachian 
catheter. 

What are the conditions which render excision of the 
lower jaw advisable? 

Malignant tumors of the mandible, malignant tumors in 
the adjacent tissues involving the bone secondarily, trau- 
matism, and necrosis may render excision advisable. 

What are the complications of dislocation of the hip? 

Fracture of the acetabulum (with or without injury to the 
pelvic viscera), fracture of some portion of the upper ex- 
tremity of the femur, rupture of the femoral artery, paralysis 
from compression or rupture of a nerve-trunk, and extensive 
laceration of the neighboring soft parts. 

What arteries need ligating in amputation at the middle 
third of the leg? Describe your method of ligating. 

The anterior tibial, the posterior tibial, and the peroneal. 
The anterior tibial artery will be found just above the inter- 
osseous membrane lying between the tibialis anticus and the 
extensor proprius hallucis. The artery should be freed from 
the surrounding structures and ligated separately or to- 
gether with the two venae comites, care being taken not to 
include the anterior tibial nerve. If the artery cannot be 
reached owing to excessive retraction, the patient should be 
turned on his face, when the weight of the stump will extend 
the limb and make the vessel much easier of access. The pos- 
terior tibial will be found behind the tibia lying upon the 
flexor longus digitorum or between it and the tibialis pos- 
ticus. It should be freed from surrounding structures and 
ligated separately or together with its two venae comites; 



392 SURGERY. 

care must 'be taken not to include the posterior tibial nerve.- 
The peroneal artery will be found behind the fibula between 
the tibialis posticus and flexor longus hallucis or surrounded 
by the fibres of the flexor longus hallucis. It should be freed 
from surrounding structures and ligated separately or to- 
gether with its two venae comites. Both the posterior tibial 
and the peroneal arteries will be found anterior to the deep 
transverse fascia of the leg. After these three arteries have 
been secured, the tourniquet should be loosened and any other 
bleeding point seized and tied. 

Where may a ligature be applied for aneurysm of the 
popliteal artery? 

Preferably at the apex of Scarpa's triangle or in Hunter's 
canal. It may also be applied in the upper portion of the 
popliteal space, just after the passage of the artery through 
the opening in the adductor magnus. 

What are the indications for litholapaxy (rapid !itho= 
trity) as compared with (a) lateral perineal lithotomy; 
(b) median perineal lithotomy; (c) suprapubic lithotomy? 

Unless some contra-indication exists litholapaxy is the 
operation par excellence. The contra-indications are : 1. 
Encysted calculus (absolute contra-indication) ; 2. A stone 
larger than 1% inches in diameter, though many surgeons 
will crush much larger stones; 3. Stones consisting of calcium 
oxalate are so hard that the crushing operation is difficult 
and sometimes impossible; 4. Excessive irritability of the 
urethra; 5. Urethral stricture of old standing not capable of 
dilatation or the existence of false passages; 6. Cystitis; 7. 
Enlarged prostate; 8. Sacculated or contracted bladder (hold- 
ing less than six ounces) ; 9. Extensive renal disease (unless 
there is no doubt that the operation may be quickly per- 
formed) . 

Lateral perineal lithotomy is indicated: 1. Where cystitis 
and great irritability of the bladder are present ; 2. In phos- 
phatic concretions; 3. If the bladder is contracted. 



SURGERY. 393 

Median perineal lithotomy is rarely performed, as the open- 
ing is much smaller than in the lateral operation. The 
advantages claimed for it are the small amount of hemor- 
rhage and the lessened danger of urinary infiltration and 
injury to the ejaculatory ducts. 

Suprapubic lithotomy is to be performed: 1. AVhen the 
stone is too large to crush; 2. If the stone is encysted; 3. If 
old strictures or an enlarged prostate is present ; 4. When the 
patient cannot assume the lithotomy position (ankylosis of 
left hip, rachitic contraction of pelvis, presence of a tumor) ; 
5. When the crushing operation is not deemed advisable in 
young boys. 

The indications for the suprapubic operation have been 
greatly extended in recent years at the expense of the perineal 
method. The only two absolute contra-indications to the 
procedure are severe septic icystitis and contraction of the 
bladder. 

What fractures do not present mobility? Under what 
circumstances is crepitus absent? 

Impacted fractures and incomplete fractures do not present 
preternatural mobility. 

Crepitus is absent in impacted fractures, in incomplete 
fractures* where, there is great separation or over-riding of 
the fragments, and where portions of muscle, tendon, or peri- 
osteum are between the fragments. 

What symptoms follow division of the radial nerve? 

Anesthesia over the radial side of the dorsal surface of the 
wrist and hand and over the dorsal surface of the thumb, 
index, middle, and radial half of ring fingers, excepting over 
the terminal phalanges. 

What conditions of the kidneys require nephrectomy? 

Any of the f ollowing conditions may require nephrectomy : 
Carcinoma, sarcoma, tuberculosis, 'calculous pyonephrosis, 
hydronephrosis, traumatic lesions (particularly if compli- 



394 SURGERY. 

cated by laceration of the peritoneum), and some cases of 
ruptured ureter. 

How may a quart of normal salt solution be prepared 
at the patient's home? 

By dissolving two teaspoonfuls of salt in a quart of water. 
The solution may be sterilized by boiling. The percentage of 
salt is not accurate, but it is near enough for practical pur- 
poses. 

What are the principal affections of synovial bursae? 

Acute simple bursitis, acute suppurative bursitis, chronic 
fibroid bursitis, chronic bursitis with effusion (house-maid's 
knee), chronic tuberculous bursitis, syphilitic and gouty de- 
posits. 

What muscles are divided in the operation for (a) di= 
verging strabismus, (b) converging strabismus? 

(a) The external rectus, (b) The internal rectus. 

How would you reduce a dislocation of the inferior 
maxillary bone? 

It is only necessary to depress the condyle below the level 
of the eminentia articularis, when the masseter, temporal and 
internal pterygoid muscles will readily draw it back into the 
glenoid cavity. The patient is to be seated, the surgeon 
stands in front of the patient and presses down upon the 
molar teeth with his two thumbs, which are guarded by a 
towel. This pressure is continued in a downward and back- 
ward direction until the condyle clears the eminentia articu- 
laris, when the chin is to be raised by the fingers. The jaw 
should be kept at rest for four or five days by a Barton 
bandage. 

Name the varieties of shou!der=joint dislocations. 

Anterior (subcoracoid, intracoracoid, subclavicular), down- 
ward (subglenoid, erecta), posterior (subacromial, subspi- 
nous), and upward (supraglenoid) . 



SURGERY. 395 

What are the possible mechanical obstructions in the 
reduction of fractures? 

Muscular spasm, the interposition of muscle or periosteum 
between the ends of the fragments, impaction of the frag- 
ments, perforation of the skin by one of the fragments, and 
effusion into a joint (in fracture of patella or of olecranon). 

What are the sources of wound infection? 

A wound may be infected 'by the foreign body making the 
wound, by any foreign substance or fluid coming in contact 
with the wound, by the blood, by the skin of the patient, by 
the hands of the surgeon and assistants, and by instruments, 
ligatures, sutures or dressings. Aerial infection is very rare, 
though possible. 

Relate the difference between a sinus and a fistula. 

A sinus is an abnormal canal leading from the skin or 
mucous membrane to an abnormal cavity. It has but one 
opening. 

A fistula is an abnormal communication between the skin 
or mucous membrane and a normal cavity. It has two open- 
ings. 

Define pyemia and give its symptoms. 

By pyemia is meant a general infection of the blood with 
pyogenic organisms. It is septicemia plus metastatic ab- 
scesses. 

Symptoms: Kepeated rigors with a markedly remittent 
temperature, exhausting diaphoresis, hyperesthesia of the 
skin, suppuration in joints not usually involved in other 
febrile affections (sterno-clavicular, sacro-iliac), and diar- 
rhea. If there is an open wound it w T ill become dry and 
glazed. Physical examination will reveal the signs of pulmo- 
nary congestion or pneumonia, metastatic abscesses may be 
detected in various portions of the body, and examinations 
of the blood show a leukocytosis. The mind is usually clear. 
Toward the termination of the affection the patient may fall 
into the typhoid state. 



396 SURGERY. 

What are the indications for castration? 

Castration may be performed for malposition, for tuber- 
culous disease, for old standing hematoceles, for simple or 
malignant tumors, after some injuries, and for chronic en- 
largement of the prostate. 

Give the causes and sequelae of suppurative middle ear 
disease. 

Causes: Inflammations- in the naso-pharynx and infected 
wounds of the membrana tympani. 

Sequehe : These may be divided into the extracranial, cra- 
nial and intracranial. 

Extracranial : Eczema of meatus, furuncles of meatus, sub- 
periosteal abscess and necrosis of tympanic plate. 

Cranial : Necrosis of ossicles, caries or necrosis of temporal 
bone, polypi, facial paralysis and mastoiditis. 

Intracranial : Extradural abscess, localized or diffused men- 
ingitis, thrombosis of the lateral sinus, and cerebral or cere- 
bellar abscess. Remember that 50 per cent, of all cases of 
brain abscess are due to this cause. 

State the causes of exophthalmos. 

Paralysis of the third cranial nerve, intra-orbital aneurysm, 
intra-orbital tumors, thrombosis of cavernous sinus, fracture 
of anterior fossa with laceration of ^cavernous sinus, em- 
pyema of the antrum, tumors of the antrum, and exoph- 
thalmic goitre. 

What are gliomata and where are they found? 

Gliomata are tumors composed of neuroglia. They occur in 
the brain, spinal cord, and rarely in the cranial nerves. The 
so-called glioma of the eye-ball is really a sarcoma. 

Mention obstacles to reduction of dislocations. 

Muscular resistance, anatomical peculiarities of the joint, 
the interposition of shreds of the capsular ligament, fracture 
of the bone involved, and the presence of adhesions (old dis- 
locations) . 



SURGERY. 397 

Define torticollis. Give the differential diagnosis of 
torticollis and cervical caries. 

Torticollis or wry-neck is a deformity due to contraction of 
certain muscles on one side of the neck. The sterno-mastoid 
is first affected, but the trapezius, the splenitis, the platysma, 
and even the cervical fascia may be involved. 

In cervical caries motion in all directions is restricted, and 
pain is elicited by pressing upon the cervical vertebrae ; in 
torticollis motion is restricted in but one direction, that in 
which the muscle involved is put upon the stretch. 

Describe hypospadias, epispadias, phimosis, and para= 
phimosis. 

Hypospadias is a malformation in which the urethra open* 
upon the under surface of the penis. 

Epispadias is a malformation in which the urethra is par- 
tially or wholly exposed on the upper surface of the penis. 

Phimosis is that condition in which the prepuce is elon- 
gated, and in which the preputial orifice is so narrow that it 
can not be retracted behind the corona glandis. 

By paraphimosis is meant a strangulation of the glans penis 
by a prepuce which has been forcibly retracted and cannot be 
replaced. 

What is genu valgum? State how genu valgum should 
be treated. 

Genu valgum or knock-knee is a deformity in which there 
is an abduction of the legs from the median line, together 
with a certain amount of external rotation. The two inner 
condyles may be brought into apposition, while the two inter- 
nal malleoli are separated. Young children (up to the fifth 
or sixth year) in whom the deformity is not great may be 
treated by mechanical appliances. If due to rickets appro- 
priate constitutional treatment must be observed. When the 
deformity is great and the age of the patient precludes the 
hope of a cure by mechanical means, osteotomy is indicated. 
The best method of performing osteotomy is that of Macewem 



398 SURGERY. 

What are the symptoms when the ulnar nerve has been 
divided on a level with the pisiform bone? 

Loss of adduction and abduction of the fingers, flexion of 
the last two phalanges of each finger, and hyper-extension at 
the metacarpophalangeal joint ("claw-hand"). The inter- 
osseous spaces become very marked from the atrophy of the 
muscles involved (the two inner lumbricales and all of the 
interossei). There is also a paralysis of the short muscles 
of the little finger, of some of the thumb muscles (adductor 
transversus, adductor obliquus, and part of flexor brevis pol- 
licis), and of the palmaris brevis. There is anesthesia of the 
ulnar side of the dorsum and palm of the hand, and of both 
dorsal and palmar surfaces of the little and ulnar side of the 
ring fingers. 

What tissues are divided in the operation for oblique 
inguinal hernia? 

Skin, superficial fascia, intercolumnar fascia, cremaster 
muscle, infundibuliform fascia, subserous areolar tissue, and 
parietal peritoneum. The superficial epigastric and the 
superficial external pudic arteries are always divided. 

What are the indications for the operation of gastros= 
tomy? 

Malignant disease of the esophagus and stricture or stenosis 
of the esophagus from any cause, when the patient is unable 
to take sufficient nourishment. 

What is the differential diagnosis between septicemia 
and pyemia? 

Septicemia occurs before the advent of suppuration, re- 
peated rigors and metastatic abscesses are absent, and the 
patient is delirious. 

Pyemia occurs after the advent of suppuration, repeated 
rigors and metastatic abscesses are present, and delirium, if 
present at all, is apt to be nocturnal. 

A differential diagnosis is frequently impossible, but the- 
oretically the points given above are those to be expected. 



SURGERY. 399 

Give the differential diagnosis between sacroiliac dis= 
ease and morbus coxarius. 

In sacro-iliac disease pressure upon the crests of the ilia 
causes pain; if the pelvis be supported, the thigh may be 
moved in all directions without much discomfort; apparent 
or -real shortening; of the lower extremity is never present. 

In morbus coxarius pressure upon the crests of the ilia 
produces no pain; motion of the thigh is accompanied by 
pain; apparent or real shortening of the lower extremity is 
always present at some stage of the affection. 

What are the principal affections of muscles? 

Contusion, sprain, rupture of sheath, rupture of muscle or 
tendon, displacement of tendon, myositis (traumatic, rheu- 
matic, acute suppurative, tubercular, syphilitic, parasitic, and 
myositis ossificans), primary tumors (angioma, fibroma, 
chondroma, myxoma, and sarcoma), and secondary tumors 
(carcinoma and sarcoma). 

Give the indications and methods for ligature of the 
common carotid artery. 

The common carotid artery is tied for aneurysm, for wounds 
of the internal or external carotid artery or their branches, 
to check malignant growths, and as a preparatory procedure 
to the removal of tumors. 

Ligation in superior carotid triangle. The patient should 
be on his back with his shoulder elevated, the head thrown 
back, and the face turned slightly to the opposite side. After 
all aseptic precautions have been carried out an incision three 
inches in length is made in the line of the artery (from the 
sterno-clavicular articulation to a point midway between the 
angle of the jaw and the mastoid process), the center of the 
incision being opposite the cricoid cartilage. The skin, super- 
ficial fascia, platysma myoides, and superficial layer of the 
deep fascia are to be divided, the sterno-mastoid muscle drawn 
outward, the tendon of the omo-hyoid drawn downward, and 
the pulsations of the artery sought for beneath the sterno- 



400 . SURGERY. 

mastoid. The sheath is now opened upon the inner side, the- 
aneurysm needle is passed from without inward, threaded, 
and withdrawn. 

Ligation in inferior carotid triangle. Patient in same 
position as before. The incision is made in the line of the 
artery from the level of the cricoid cartilage to the sterno- 
clavicular articulation, and divides skin, superficial fascia, 
platysma, and superficial vessels and nerves. The superficial 
layer of the deep cervical fascia is then divided, the sterno- 
mastoid muscle drawn outward, and the sterno-hyoid and 
sterno-thyroid muscles drawn inward. The sheath is opened 
upon the inner side, and the aneurysm needle passed from 
without inward. 

What operations are performed for intractable neural= 
gia of the fifth nerve? 

Neurotomy, nerve stretching, removal of Meckel's ganglion, 
neurectomy, and removal of the Gasserian ganglion. Accord- 
ing to the symptoms, one or more of the following nerves may 
be resected: Supra-orbital, supra-trochlear, infra-orbital, in- 
ferior maxillary division of the fifth, lingual, inferior dental, 
and mental. 

State the most common seat of fracture of the clavicle 
and describe a method of treatment. 

At the outer end of the middle third of the bone. 

Sayre's method. Three strips of adhesive plaster three and 
one-half inches wide and long enough to encircle the chest and 
arm are required. A loop is made in the end of the first strip ; 
this loop is secured by stitches and made to encircle the arm 
close to the axilla, the non-adhesive surface of the plaster 
being next to the skin. The shoulder is then drawn backwards 
and the adhesive strip carried around the chest from behind 
forward (adhesive surface next to skin), passing over the 
front of the chest, under the axilla, and finally attached to the 
part crossing the back. The elbow of the injured side is now 
brought forward and the hand placed upon the sound shoul- 



SURGERY. 401 

der. As the loop of the first strip acts as a fulcrum, the shoul- 
der and outer extremity of the clavicle are carried backward. 
With the arm in this position the end of the second strip is 
fixed to the sound shoulder, and the strip is then brought 
downwards across the back to the elbow of the injured side 
(a hole being cut in the plaster to accommodate the olecra- 
non) , upwards across the front of the chest and forearm, and 
fastened to the other end over the top of the sound shoulder. 
This strip holds the shoulder back and keeps it raised. The 
third strip is passed horizontally about the chest and forearm 
to hold the extremity against the body. A towel should be 
placed in the axilla, and all contiguous cutaneous surfaces 
should be separated by pieces of lint. This position is to be 
maintained until union occurs (about three or four weeks), 
and the movements of the arm should be restricted for a week 
or so longer. 

Give the causes of atrophy. 

Causes: 1. Diminished functional activity; 2. Defective 
nutrition; 3. Pressure; 4. Nervous influence (neuropathic 
atrophy) ; 5. Senility. 

What symptoms follow division of the facial nerve? 

Paralysis of the same side of the face without implication 
of palate or uvula (it is presumed that the nerve has been 
divided after its exit from the skull). The paralyzed side of 
the face is immobile, devoid of expression, and the natural 
folds and wrinkles are obscured. The eye-lids cannot be 
completely closed, the eye-ball rolling upward and outward 
when forcible closure is attempted. Epiphora is present 
from the drooping of the lower lid. The lips cannot be 
firmly closed, and whistling is impossible. If attempts are 
made to move the face (to show the teeth or laugh) marked 
asymmetry is produced, the face being drawn toward the 
non-paralyzed side. Owing to the paralysis of the bucci- 
nator,, food collects between the teeth and the cheek. 
26 



402 SURGERY. 

What method of treatment affords the most prompt 
relief in paronychia? 

Evacuation of the pus or inflammatory exudate by means 
of an incision, the introduction of a small strip of iodoform 
gauze for drainage, and the application of a moist antiseptic 
dressing. 

Describe the operation for ligature of the subclavian 
artery in its second part. 

The patient should be in the dorsal position, with a cushion 
beneath the shoulders, face turned to the opposite side, and 
the shoulder depressed. After all aseptic precautions have 
been carried out, the skin should be drawn down over the 
clavicle, and an incision made over the bone extending from 
the middle of the clavicle almost to the sterno-clavicular 
articulation. The skin is then allowed to retract, and the 
wound will be half an inch above the clavicle. This incision 
divides the skin, superficial fascia, platysma myoides, and the 
superficial layer of the deep icervioal fascia. The clavicular 
head of the sterno-mastoid muscle should then be divided, 
and any veins overlying the prevertebral fascia covering the 
scalenus anticus ligated. The prevertebral fascia is then 
incised, the phrenic nerve drawn inward, and the outer two- 
thirds of the anterior scalenus muscle divided close to its 
attachment to the first rib. Care must be taken not to wound 
the anterior jugular, external jugular, internal jugular or 
subclavian veins, the phrenic nerve or the pleura. The needle 
is passed from before backward and from below upward. 

What are the varieties of ankylosis? 

Incomplete or fibrous and complete or bony. Ankylosis is 
also spoken of as being either true (involvement of articular 
structures) or false (result of extra-articular lesions). 

When is operative interference advisable in the treat= 
ment of malignant tumors? 

Operative interference is advisable when the tumor can be 



SURGERY. 403 

thoroughly removed, when the operation will diminish pain 
or make the patient more comfortable, and when it will 
lengthen the life of the patient. 

Describe the several varieties of clubfoot. 

Talipes equinus. The heel is drawn up and the patient 
walks upon his toes. 

Talipes calcaneus. The toes are raised from the ground 
and the patient walks upon his heel. 

Talipes varus. The anterior half of the foot is addueted, 
the inner side of the foot is raised, and the patient walks upon 
the outer side. 

Talipes valgus. The anterior half of the foot is abducted 
and everted, the patient resting upon the inner side of the 
foot. Various combinations of these forms are indicated as 
follows : Talipes equino-varus, talipes equino-valgus, talipes 
calcaneo-varus, and talipes calcaneo-valgus. 

Name the most common varieties of fistula. 

Fistula in ano (complete, blind internal, blind external), 
vesico-vaginal, urethro-vaginal, recto-vaginal, urinary, sali- 
vary, biliary, and intestinal. 

What is lupus? 

Lupus vulgaris is a chronic inflammatory disease of the 
skin and mucous membranes due to the tubercle bacillus, and 
characterized by the formation of nodules of granulation tis- 
sue. These nodules usually ulcerate (lupus exedens), but 
such is not always the case (lupus non-exedens) . 

What are the indications for enucleation of the globe? 

Malignant disease, either primary or extending from adja- 
cent tissues, rupture and collapse of eye-ball, a large irregular 
foreign body in the eye not capable of being successfully 
removed, a large wound in the dangerous region in which 
little hope of obtaining useful sight remains, a small wound 
in the dangerous region with commencing irido-cyclitis, a small 
foreign body not removable by the electro-magnet and causing 



404 SURGERY. 

inflammation and shrinking, a wound in the dangerous region 
complicated with traumatic cataract, a corneal wound in 
which severe iritis and panophthalmitis develop in spite of 
treatment, and any case in which sympathetic ophthalmia is 
threatened. (Modified from Jacobson.) 

Give the symptoms, diagnosis, and treatment of phle= 
bitis. 

Symptoms : The vessel affected becomes swollen, hard, and 
painfuL Localized enlargements corresponding to the posi- 
tion of the valves are observed. The overlying tissues are 
dusky and congested, and there may be some edema in the 
area drained by the vein. The part is hot to the touch and 
the patient usually has fever. If suppuration occurs the 
symptoms are those of a localized abscess. 

Diagnosis: In lymphangitis the redness is brighter and 
more localized, enlarged and painful glands are present, there 
is no hard cord-like vein, and the swelling is much less marked. 
In erysipelas the redness is characterized by an abrupt raised 
margin, and gastric disturbances are frequently present. 

Treatment: Absolute rest in bed, with elevation of the 
affected extremity to promote the return of venous blood. 
The affected area is covered with a mixture of equal parts of 
extract of belladonna and glycerine, and the limb is swathed 
in a thick layer of cotton and lightly bandaged to a splint.. 
The diet should be nutritious and non-stimulating. When 
the inflammatory symptoms have subsided, and the clot has 
had time to become organized or absorbed, massage should be 
practiced to get rid of the edema and inflammatory thicken- 
ing. If an abscess forms it should be opened antiseptically. 

In septic phlebitis, if seen early, the vein should be ex- 
posed, ligated, the whole of the infective clot turned out, the 
vessel swabbed out with pure carbolic acid or bichloride solu- 
tion (1-500), and stuffed with antiseptic gauze. If the 
deeper veins are infected and this treatment is impossible, 
amputation may be demanded, provided that general infec- 
tion has not taken place. 



SURGERY. 405 

Give the causes, symptoms, and treatment of acute 
vaginitis. 

Causes : The presence of irritating foreign bodies, the use 
of irritating injections, the contact of irritating secretions, 
the irritation of excessive coition, and infection with gonor- 
rhea. 

Symptoms : Local heat, pain, and muco-purnlent discharge. 
Inspection shows congestion and sometimes excoriations of 
the vaginal mucous membrane. 

Treatment : Rest in bed, saline cathartics, and frequent hot 
hip-baths. The vagina should be copiously douched twice 
daily with borax (one dram to a quart of water) or with 
liquor plumbi subacetatis (half a fluid-ounce to a quart of 
water). As soon as the acute symptoms have subsided the 
walls of the vagina should be separated by a fold of lint 
soaked in oxide of zinc cream. This lint should be carried 
well up into the posterior fornix, allowed to protrude at the 
vulva, and changed every 24 hours. After the disease has 
subsided the parts should still be douched ocasionally to 
prevent recurrence. 

In gonorrheal vaginitis the vagina should be washed out 
every two or three hours, first with a pint or two of an alka- 
line solution, then with a pint of plain water, and then with 
a pint of a medicated solution (acetate of lead, acetate of 
zinc, sulphate of zinc, protargol, alum, tannin). 

Define homologous tumor, heterologous tumor. 

A homologous tumor is a tumor consisting of tissue iden- 
tical with that of the part in which it grows. 

A heterologous tumor is a tumor consisting of a different 
tissue from that of the part in which it grows. (These tumors 
are more properly called heterotopic tumors.) 

How are dislocations distinguished from fractures? 

Dislocations are characterized by more or less immobility, 
by the absence of crepitus, and by the fact that the deformity 
does not usually recur after reduction. 



406 SURGERY. 

Fractures are characterized by preternatural mobility, by 
the presence of crepitus, and by the fact that the deformity 
usually recurs after reduction. 

What is milium? Give the treatment. 

Milium is an affection characterized by the appearance of 
small, pearly, non-inflammatory elevations, which result from 
the accumulation of inspissated sebum in ducts, the outlets of 
which have been occluded. 

Treatment: The lesion should be excised, the contents ex- 
pressed, and the same remedies employed as in seborrhea 
(improvement of general health, relief of constipation, and 
the 'application of ointments of sulphur, mercury, tar, car- 
bolic acid, or resorcin) . 

Describe an operation for circumcision. 

After all aseptic precautions have been carried out, the 
prepuce is drawn forward and grasped by a clamp placed 
just in front of the glans. The portion of the prepuce in 
front of the clamp is then cut off with a sharp bistoury and 
the clamp removed. It will be observed that the skin has been 
removed, but that the mucous surface of the prepuce still 
covers the glans. One blade of a pair of scissors is now intro- 
duced into the preputial orifice and the mucous layer divided 
down to its attachment to the corona. All adhesions between 
the prepuce and glans must be thoroughly broken up and the 
smegma removed. The entire mucous surface of the pre- 
puce is to be trimmed away to within an eighth of an inch of 
its attachment to the corona. Special attention should be 
given to the removal of sufficient tissue from the under side 
of the penis in order to avoid an unsightly projection in the 
neighborhood of the frenum. Hemorrhage should now be 
controlled, the edges of the wound adjusted by a few fine 
catgut sutures, and the line of incision covered by some non- 
irritating antiseptic dressing. 

Give the local treatment of venereal bubo. 

Syphilitic bubo requires no local treatment. 



SURGERY. 407 

Gonorrheal 'bubo may sometimes be aborted by the use of 
pressure and iodine. If the gland suppurates it should be 
incised under antiseptic precautions, curetted, and treated 
like any abscess. If the suppuration is within the gland and 
limited by the capsule the entire mass should be dissected out 
and the wound closed by primary suture. The latter treat- 
ment is the best method of dealing with suppurating buboes, 
provided that it is adopted at the proper time. 

Give the palliative and the remedial treatment of hy= 
drocele. 

Palliative treatment: Tapping, the use of the suspensory, 
and evaporating lotions (when inflammation of the testicle 
is present). 

Remedial treatment : Tapping and injection should never 
be employed. The open method of treatment is now gener- 
ally adopted. One of two methods may be pursued: 1. The 
cavity of the tunica vaginalis may be opened and the tunica 
stitched to the skin. The cavity is drained, washed out daily, 
and the drainage tube gradually shortened. Instead of a 
tube, the cavity may be packed with iodoform gauze. 2. 
The parietal layer of the tunica vaginalis may be excised. 

Give the differential diagnosis of congenital talipes 
equino=varus and paralytic talipes equino=varus. 

In congenital talipes equino-varus the affection exists from 
birth, it is usually bilateral, the circulation is good, there is 
but little wasting of the muscles, the electric reactions are not 
much impaired, the growth of bone is much as usual, and 
furrows are present in the sole. 

In paralytic talipes equino-varus the affection is not de- 
veloped until the second or third year (ushered in by convul- 
sions and fever), it is more frequently unilateral, the circula- 
tion is feeble, the muscles show extreme wasting, electrical 
reactions are almost entirely absent in the paralyzed muscles, 
the growth of the bones is considerably diminished, and there 
are no furrows in the sole (after Tubby). 



408 SURGERY. 

Describe an approved method for the removal of im= 
pacted cerumen. 

The external auditory meatus is to be syringed with warm 
water (105° F.), to which some bicarbonate of soda has been 
added, and the syringing continued until the canal has been 
thoroughly cleansed. The soda solution is then to be washed 
out with sterile water, the ear wiped dry, and a cotton plug 
worn until bedtime. If the mass should prove obdurate, a 
little warm sweet oil may be dropped into the meatus several 
times during the succeeding 24 hours, and the attempt re- 
newed upon the following day. 

Define malignant pustule and give treatment. 

Malignant pustule or anthrax carbuncle is a local lesion 
produced by infection with the bacillus anthracis. It differs 
from ordinary carbuncle in the following respects: Presence 
of a central depressed blackish slough, absence of localized 
pain, absence of suppuration (unless mixed infection is pres- 
ent), and the constitutional symptoms are more marked. 

Treatment: Complete excision at the earliest possible mo- 
ment. The incisions should be carried wide of the disease, 
and the resulting wound should be carefully swabbed over 
with pure carbolic acid or with a solution of zinc chloride 
(1:8). The constitutional treatment should be of a support- 
ing character. 

What are the parietal effects of a severe blow upon the 
abdomen? 

Swelling, discoloration, tenderness, and pain. If a vessel 
of considerable size is lacerated a large extravasation of blood 
-dll take place, which may descend into the scrotum. Rup- 
ture of one of the muscles of the abdominal wall may occur, 
and this is most frequently observed in the rectus. As far 
as the abdominal parietes are concerned, contusions may re- 
sult in localized peritonitis, abscess, or in ventral hernia. 



SURGERY. 409 

— Describe the symptoms of fracture of the base of the 
skull in the middle fossa. 

Hemorrhage from the external auditory meatus, or from 
the nose. The 'blood may be swallowed and subsequently 
vomited. Cerebro-spinal fluid may be discharged from the 
external auditory meatus, and, when present, is one of the 
most characteristic signs of fracture in this situation. If 
the facial and auditory nerves are injured as they lie in the 
external auditory meatus, there will be signs of paralysis of 
the muscles of expression and deafness upon the affected side. 
In addition to these local signs, symptoms of concussion, of 
compression, or of laceration of the brain may be present. 

What general methods obtain in plastic operations? 

Displacement: Stretching or sliding of tissues. 1. Simple 
approximation after freshening the edge; 2. Sliding into 
position after the transference of tension to adjoining 
localities. 

Interpolation : The tissue is taken from adjacent regions, 
from a limb, or from another person. 1. Transferring a flap 
with a pedicle; 2. Transplanting without a pedicle (includ- 
ing skin-grafting) . 

Retrenchment: The removal of redundant material causing 
cicatricial contraction. (Abbreviated from Keen and White.) 

What is the treatment of diphtheritic stenosis of the 
larynx? 

Intubation or tracheotomy. The usual treatment of diph- 
theria should also be instituted or continued (injection of 
diphtheria antitoxin, administration of whiskey, hypoder- 
matic injections of strychnine, absolute rest in bed, nutritious 
fluid diet). If tracheotomy has been performed the temper- 
ature of the room should be maintained at 80° F., and the 
air kept moist with steam. 

Describe a compound fracture. 

A compound fracture is one in which the seat of fracture 



410 SURGERY. 

communicates with the external air. Such a fracture may 
be compound through the skin or through the mucous mem- 
brane. These fractures are also called open fractures. 

Give the etiology, varieties, and symptoms of erysipelas. 

Etiology: Infection with the streptococcus erysipelatis. 

Varieties: Cutaneous, cellulo-cutaneous (phlegmonous),, 
and cellular (cellulitis). 

Symptoms: Cutaneous erysipelas is usually ushered in by 
a chill and more or less gastric disturbance. Within 24 hours 
a rash appears in the neighborhood of the wound. There is 
increased tension in the part and a sensation of itching. The 
rash is yellowish-red in color, disappearing upon pressure, 
and has a characteristic elevated border. The area affected 
is well denned, and the margins usually present an irregular 
zigzag outline. When the inflammation reaches its height 
the glazed area is covered with vesicles or bulla? filled with a 
clear fluid, which soon becomes turbid. The rash advances 
more or less rapidly with a continuous margin (remaining 
in one situation for about four days), and as it extends to 
new areas it fades in the region first involved and undergoes 
branny desquamation. The neighboring lymphatic glands 
are usually enlarged and painful. Fever is present as long 
as the rash persists. In severe cases the fever is at first 
sthenic, the puke full, and the delirium noisy and active, but 
the pulse subsequently becomes quick and weak, and there is 
low muttering delirium and great prostration. 

What is shock, and how should it be treated? 

Shock is the immediate constitutional effect of an injury. 

Treatment: In mild cases very little is needed except rest 
in the recumbent position and the exhibition of some pungent 
aromatic to the nostrils. In more severe cases the patient 
must be put absolutely at rest, surrounded by blankets and 
hot water bottles, and all external sources of irritation re- 
moved. Over-stimulation should be avoided, and in many 
cases a cup of hot beef tea may do as much good as a stronger 



SURGERY. 411 

stimulant. If the patient appears to be in imminent danger, 
however, more active measures must be adopted. The head 
should be kept low and surrounded with flannel cloths wrung 
out of hot water and frequently renewed. The extremities 
should be wrapped in blankets and external heat applied, 
care being taken not to burn the patient. Ammonia should 
be exhibited to the nostrils and small quantities of brandy 
given by the mouth. If the patient cannot swallow, the 
brandy may be diluted and given by the rectum. The rectal 
injection of two or three pints of warm normal saline solution 
(100° F.) is highly recommended. Ether, digitalis, atropine, 
or strychnine may be given subcutaneously, the latter drugs 
being particularly valuable. If the shock is combined with 
loss of blood, a pint of sterile normal saline solution should 
be injected beneath the skin or into a vein. If a mangled 
limb seems to act as a source of depression it may be proper,, 
under certain circumstances, to amputate at once. 

What are the symptoms and treatment of a sprain? 

Symptoms : The patient immediately experiences severe 
sickening pain. Swelling soon makes its appearance, due at 
first to extravasation of blood and subsequently to the effu- 
sion of inflammatory products. The patient is unable to bear 
any weight upon the injured extremity, and motions of the 
joint are attended by exacerbations of the pain. 

Treatment: Early and systematic massage is invaluable in 
these injuries. Ten or twenty minutes is usually enough for 
the first treatment, and the period can be lengthened upon 
the following days. During the intervals between the mas- 
sage of the part, it should be kept at rest upon a well-padded 
splint and moderate compression applied. The immediate 
application of cold, followed by heat, is of great advantage 
in some cases. If the sprain is in the ankle or wrist, the 
patient should be encouraged to move his toes or fingers while 
the massage is being performed. The old treatment con- 
sisted in keeping the part at rest until all pain and swelling 



Y 



412 SURGERY. 

had disappeared, and then employing massage and passive 
motion. 

How and in what part of the inferior maxillary bone is 
fracture most liable to occur, and what is the treatment? 

The inferior maxillary bone is usually fractured by direct 
violence. 

The most frequent site of fracture is at a point just ante- 
rior to the mental foramen. 

Treatment: Reduction of the displacement, the application 
of a Barton bandage and the maintenance of the oral cavity 
in as aseptic a condition as possible. In some cases a leather 
or pasteboard splint may be applied over the point of the 
chin. If there is a great displacement a Hammond splint 
may be placed about the teeth or, if these are defective, 
Kingsley's apparatus may be employed. Some few cases may 
require wiring of the fragments. The parts are to be kept 
at rest for about three weeks, the patient being restricted to 
a fluid diet. 

Describe enucleation of the eye=ball. 

Bonnet's method: All aseptic precautions having been car- 
ried out, the conjunctiva near the cornea is grasped by for- 
ceps and divided with scissors entirely around and close to 
the corneal margin. The conjunctiva is loosened up from 
the eye-ball and the dissection carried well back in every 
•direction. The recti muscles are now caught up separately 
by a strabismus hook and their tendons divided close to the 
ball. After the orbital tissues have been well dissected away 
from the ball the enucleation scissors are passed back in the 
orbit until they touch the optic nerve, when their blades are 
opened and the nerve divided as far back as possible. The 
oblique muscles and other remaining tissues are now quickly 
severed, the hemorrhage is checked by hot water or torsion, 
and the orbit flooded with a hot bichloride solution (1: 5000). 

A drainage tube is then inserted into the cavity and an 
antiseptic dressing applied. 



SURGERY. 413 

How is resection of the spinal accessory nerve effected? 
What are the reasons for this operation? 

After all aseptic precautions have been observed, an inci- 
sion is made along the anterior border of the sterno-mastoid 
muscle, extending from the mastoid process to the cornu of 
the hyoid bone and avoiding the external jugular vein. This 
incision divides skin, superficial fascia, platysma, a branch 
of the auricular is ma gnus, and the deep fascia. The sterno- 
mastoid is now drawn outward, and the nerve ( with its accom- 
panying sterno-mastoid artery) can be felt just below the 
transverse process of the atlas. The nerve emerges from 
beneath the posterior belly of the digastric and lies upon the 
levator anguli scapulae, beneath the prevertebral fascia. It 
enters the deep surface of the sterno-mastoid muscle midway 
between its two borders and one inch below the tip of the 
mastoid process. A portion of the nerve is now excised, the 
external wound sutured, and an aseptic dressing applied. 

The spinal accessory nerve is excised for spasmodic torti- 
collis of central origin. 

What are the methods of reduction in sub=coracoid dis- 
location of the humerus? 

1. Reduction by manipulation (Kocher's, Smith's). 

2. Extension and counter-extension. 

3. Traction in an outward and upward direction. 

How would you arrest epistaxis? 

If position, rest, cold, hot water, pressure, and spraying- 
with peroxide or with a 5 per cent, solution of antipyrine 
(with 2 per cent, cocaine) are inefficient, more^ active meas- 
ures must be adopted. If the bleeding point can be seen it 
should be cauterized (electricity, chromic acid). When other 
means fail the anterior nares should be packed with a strip 
of sterile gauze, the initial extremity of which is carried well 
back toward the naso-pharynx. In rare cases it may be 
necessary to plug the posterior nares by means of Belocq's 
cannula or a soft rubber catheter. Plugs of gauze should 
never be let in the nose unchanged for more than 24 hours. 



414 SURGERY. 

Differentiate between the following forms of inflam= 
mation: Serous, sero=fibrinous, serohemorrhagic. 

In serous inflammation there is a copious exudation of fluid 
with comparatively little cellular matter. 

In sero-fibrinous inflammation the exudate contains more 
fibrin, and shows a marked tendency to clot. 

In sero-hemorrhagic inflammation the exudate contains 
large numbers of red blood corpuscles, and is correspondingly 
tinged. > 

What is hare=lip? Give the treatment of hare=lip. 

By hare-lip is meant a congenital fissure of the upper lip 
which may extend for a variable distance through the soft 
tissues. It may be associated with a cleft in the palate. 

Treatment : A straight bistoury should be introduced just 
above the angle of the fissure, and both sides of the cleft 
pared by cutting through the lip in a crescentric manner so as 
to constitute a slight angular projection or prolabium when 
the freshened surfaces are brought into apposition. If the 
nose is much flattened more tissue should be removed from 
the outer than from the inner side, so that when the parts are 
sutured together the nostrils become as nearly symmetrical 
as possible. By paring the edges in a curved or angular 
manner the depth of the lip is increased to allow for subse- 
quent contraction. Two deep silk-worm-gut sutures should 
be introduced, one just above the red margin and one close 
to the nose. The vermilion borders must be accurately ap- 
proximated and the edges of the wound carefully brought 
together with cat-gut sutures. The dressing consists of gauze 
and collodion. The gauze is cut in the shape of a paddle, the 
broad ends being fastened to the cheek. This should be so 
applied as to prevent tension upon the wound. The silk- 
worm-gut sutures are removed upon the fourth day. The 
operation above described is that of Malgaigne. Other opera- 
tions are those of Nelaton, Rose, Mirault, and Konig. Double 
hare-lip may sometimes be treated by operating upon each 



SURGERY. 415 

side, as in a unilateral «cleft, but if the os incisivum projects 
it must be either removed or replaced. 

Give the etiology of inflammation. 

Predisposing local causes: Defective circulation, loss or 
impairment of the nervous supply of a part, a previous 
attack of inflammation. 

Predisposing constitutional causes: Anything producing 
an impairment of the general health, such as old age, weak 
action of the heart, an unhealthy condition of the blood, and 
the presence of some constitutional disease. 

Exciting causes: Mechanical irritants, heat, cold, electric 
irritants, toxic irritants (chemical, vegetable, animal), and 
micro-organisms. 

Give the treatment of fracture of the ribs. 

The affected side should be firmly strapped with strips of 
adhesive plaster so as to limit its range of motion. These 
strips (2 inches in width) should extend beyond the median 
line both anteriorly and posteriorly, and are to be applied 
from below upward, each strip overlapping above one-half of 
its predecessor. Each strip should be put on while the chest 
is in a state of forcible expiration. If the patient has ad- 
vanced pulmonary emphysema or chronic bronchitis, strap- 
ping is not advisable, as it adds to the respiratory difficulty, 
and in such a case the patient must be placed in bed or 
propped up, and the fracture left to take care of itself. 
Strapping is also contra-indicated if the broken fragments 
are driven inwards, and if the fracture is in the lower part 
of the chest and the pressure irritates the diaphragm, causing 
hiccough. If there are associated injuries of the thoracic 
viscera, pneumo-thorax, or hemothorax, they must be appro- 
priately treated. 

Mention the varieties of hip=joint dislocation, and de= 
scribe in detail two of these varieties. 

Dorsal, dorsal below the tendon (sciatic), thyroid, and 
pubic. 






416 SURGERY. 

Dorsal dislocation : The head of the bone lies upon the dor- 
sum ilii, the trochanter is above Nelaton's line and nearer to 
the anterior superior spine, the ilio-tibial band is relaxed, and 
there is a shortening of two or three inches. A marked 
hollow is present in the upper part of Scarpa's triangle, and 
the head of the bone cannot be felt in its usual position. The 
thigh is flexed, adducted, and inverted, so that the axis of the 
femur crosses the lower third of the sound thigh and the ball 
of the toe rests upon the opposite instep. The ligamentum 
teres is torn and the capsule is lacerated. The small external 
rotator muscles are usually lacerated, as may also be the 
glutei and the pectineus. The great sciatic nerve may be 
contused or compressed. The ileo-femoral ligament is un- 
injured. 

Dorsal below the tendon (sciatic) : The signs of this dis- 
location are somewhat similar but less marked than in the 
preceding form. There is not so much shortening, since the 
intact obdurator internus tendon prevents the head of the 
bone from traveling upward. The shortening is not more 
than one-half inch or an inch, but it becomes more apparent 
upon flexing the thigh (Allis). The thigh is flexed, ad- 
ducted, and inverted, but the axis of the femur crosses the 
opposite knee and the great toe rests against the ball of the 
great toe of the sound side. The head of the bone is palpated 
with great difficulty owing to the greater thickness of the 
gluteal muscles at this level. Practically the same muscles 
and ligaments are injured as in the dorsal variety. The head 
of the bone is below the tendon of the obturator internus, 
whereas in the former dislocation it is above it. 

Make a differential diagnosis of coma from injury, apo= 
plexy, uremia, opium poisoning, and alcoholic intoxication. 

Concussion: The individual is pale, the pulse is feeble and 
fluttering, the respirations are sighing, the skin is cold and 
clammy, and the urine and feces may be passed involuntarily. 
The pupils vary, sometimes being unequal, but they usually 
react to light. Convulsions occasionally occur. Paralysis is. 



SURGERY. 417 

not present, and examination of the extremities may give 
some evidence that they have not lost their sense of feeling. 
The patient can usually be aroused by shouting. 

Compression : The unconsciousness is complete and the 
pupils are dilated and do not respond to light. The skin is 
usually hot and bathed in perspiration. The respirations are 
slow, stertorous, and have a peculiar puffing character, due 
to the paralysis of the muscles of the cheeks. The bladder 
and intestines are usually paralyzed, but the incontinence of 
retention may be present. The pulse is slow, full, and fre- 
quently irregular. The whole body may be paralyzed, but 
hemiplegia is the form most commonly observed. Mono- 
plegias also occur, and are extremely valuable from the 
standpoint of localization. 

Apoplexy: Absolute unconsciousness, stertor, hemiplegia 
or complete paralysis are present, Aid in the diagnosis is 
furnished by the age of the patient and the condition of the 
arteries. The temperature is usually higher in one axilla, 
and conjugate deviation may be observed. The face is 
flushed, the conjuctiva is injected, the pulse is full and slow, 
and the breathing is stertorous. Urine and feces may be 
passed involuntarily, and convulsive seizures are not infre- 
quent. 

Uremia: Paralysis and stertor are absent (unless apoplexy 
co-exists). The legs may be edematous and the urine contains 
albumin and casts. The breath is urinous, arterial tension is 
high, and the aortic second sound is accentuated. 

Opium poisoning: Paralysis is not present, and the pupils 
are pin-point and will not dilate. The odor of laudanum 
may be detected upon the breath. The pulse and respira- 
tions are slow. 

Alcoholic intoxication: Unconsciousness is not complete 
and it is usually possible to arouse the patient. Some aid 
may be furnished 'by the appearance of the patient, but this 
is frequently misleading. Although the breath may be alco- 
holic, it must be remembered that alcohol may have been 
27 



418 SURGERY. 

given in an attempt to revive the individual. The pupils are 
usually contracted but dilate when the patient is aroused. 
The temperature is generally subnormal. 

Give the symptoms and treatment of hammertoe. 

Symptoms : Hyper extension of the first phalanx, flexion of 
the second to an acute angle, and either flexion or extension 
of the terminal phalanx. The first interphalangeal joint rubs 
against the upper leather of the shoe, and the patient walks 
upon the extremity of the terminal phalanx. Corns are pres- 
ent over the points of pressure, and there is a subcutaneous 
bursa over the head of the first phalanx, causing great pain 
and discomfort. The affection is most frequently observed 
in the second toe. 

Treatment : If the case is seen early, treatment may be 
commenced with the wearing of correctly shaped boots, but 
the affection has usually progressed so far that the excision 
of the first interphalangeal joint or amputation of the toe is 
required. The first operation is the preferable one, since 
amputation is frequently followed by hallux valgus. 

Describe dermoid cysts. In what situations are they 
most commonly found? 

Dermoid cysts are cysts composed of structures which 
naturally belong to the skin or mucous membranes, but which 
occur in situations where these structures are not normally 
found. They may contain all the elements of the skin, such 
as stratified epidermis, a papillary layer, and even subcuta- 
neous connective tisue. Hair follicles and sebaceous glands 
are frequent, and hairs of varying lengths are almost always 
present. Some forms of dermoids contain teeth, nerve tissue, 
muscle, and bone, and structures resembling intestine are not 
of uncommon occurrence. They have been classified by 
Bland Sutton into sequestration dermoids, tubulo-dermoids, 
and ovarian dermoids. 

Dermoid cysts are found in the ovary, in the testicle, in the 
peritoneum, at the outer angle of the orbit, above the nose, in 



SURGERY. 419 

the neck, in the floor of the month, in the membranes of the 
brain, and elsewhere. 

Describe suprapubic lithotomy. 

A silver catheter is introdnced into the bladder which i3 
to be filled with about ten ounces of a 3% solution of boric 
acid. Some surgeons still distend the rectum by the intro- 
duction and subsequent filling of a rubber bag. This is 
hardly necessary, but if the operator employ the rectal bag 
it should never contain more than 8 ounces, it should be 
inserted after the catheter has been introduced into the 
bladder, and before the bladder is distended with the boric 
acid solution. An incision about 2% inches in length is made 
in the median line just above the symphysis and is subse- 
quently carried down to the areolar tissue in front of the 
bladder. If the peritoneum bulges into the upper angle of 
the wound it should be displaced upward out of harm's way. 
There should be no difficulty in recognizing the bladder when 
distended and containing the curved end of the silver cathe- 
ter. Two silk ligatures are now passed through the bladder- 
wall and the bladder is opened between them by a quick 
thrust of the knife. The index-finger is passed into the wound 
and locates the stone, which is to be removed by the finger, 
by the scoop, or by forceps. 

Give the symptoms and treatment of any one form of 
acute intestinal obstruction. 

Strangulated hernia. Symptoms: Pain at the hernial ori- 
fice and radiating toward the umbilicus. The hernia is hard, 
tense, and gives no impulse on coughing. Vomiting which is 
projectile, without preceding nausea, at first gastric, then 
bilious and soon assuming a stercoraceous character. Abso- 
lute constipation. Shock. Subnormal temperature. 

Treatment: Immediate herniotomy. 

Give any one of the dislocations of the knee=joint and 
the method of reduction. 

The anterior dislocation of the upper end of the tibia. 



420 SURGERY. 

The thigh, should be flexed upon the pelvis, entension is 
made upon the leg, and the surgeon endeavors to bring the 
bones into their normal relation by pressure and manipula- 
tion. The parts should be massaged from the first, but 
passive motion should not be employed until the end of the 
second week and then with great caution. The patient should 
subsequently wear an artificial knee-cap to prevent a recur- 
rence of the displacement. 

Define necrosis and give the cause and surgical treat= 
ment. 

By necrosis is meant the death of bone in mass. 

Causes. Denudation of periosteum. Periostitis, ostitis, or 
osteomyelitis. Tuberculosis. Syphilis. Exposure to the 
fumes of phosphorus. The excessive administration of 
mercury. 

Surgical treatment : Sequestrotomy. 

Give the symptoms of shock, and state when the prog= 
nosis is grave. 

Symptoms, The skin is pale, cool, and bathed in perspira- 
tion, the pulse is rapid and weak, the respirations are shallow 
and irregular, and the temperature is subnormal. Nausea 
and vomiting may occur, and the feces and urine may be 
passed involuntarily. The symptoms vary according to the 
severity of the injury, and the patient may suffer from any- 
thing from a sensation of momentary weakness and faintness 
to a most profound muscular relaxation and unconsciousness. 

The prognosis is grave when a vital part is injured, when 
the injury is extensive, entailing a continued source of irrita- 
tion and depression, when a reaction as regards temperature 
is not observed within four hours after the reception of the 
injury, when large quantities of blood have been lost, and in 
old people who are the subjects of degenerative changes. 

How would you proceed surgically to remove the fluid 
in a case of ascites? 

The patient is seated in a chair and the abdomen is encir- 



SURGERY. 421 

eled with, a flannel binder, the ends of which are split to 
within six inches of the median line. The untorn portion of 
the binder is placed over the front of the abdomen and the 
divided ends are crossed behind and held by assistants so as 
to make continuous pressure upon the abdominal contents. 
A spot is selected in the median line below the umbilicus 
where absolute dulness is obtained upon percussion. After 
all aseptic precautions have been observed, the skin over this 
small area is anesthetized by a drop of carbolic acid or by the 
intradermic injection of Schleich's solution, a small incision 
is made through the skin, and a suitable trochar and cannula 
is inserted. The fluid should be withdrawn slowly, icontinu- 
ous pressure being made upon the abdominal contents by 
means of the flannel binder. All of the fluid should not be 
withdrawn. After the withdrawal of the cannula the small 
wound should be closed with aseptic gauze and sterile col- 
lodion. 

Differentially diagnose impacted and non=impacted frac= 
ture of the neck of the femur. 

Impacted Fracture. Non-impacted Fracture. 

Crepitus is absent. Crepitus may be obtained. 

Eversion is less marked and inversion Eversion is present. 

may be present (rare). 

The head of the femur moves under The head of the femur does not move 

the finger when the extremity is under the finger when the extrem- 

rotated. ity is rotated. 

The shortening is not overcome by Shortening is overcome by extension. 

moderate extension (danger !). 

The symptoms of fracture are not so The symptoms of fracture are more 

marked. marked. 

The individual may be able to walk The individual is unable to walk. 

(do not allow her to try). 

Name and describe the different varieties of fracture. 

Simple (subcutaneous) : No communication with external 
.air. 

Compound (open) : Communication with external air. 
Complete : The entire thickness of the bone is involved. 



422 SURGERY. 

Incomplete: The entire thickness of the hone is not in- 
volved. 

Multiple: The hone is fractured in more than one place 
and the lines of fracture do not communicate. 

Single : The bone is fractured in but one place. 

Comminuted : The bone is fractured into a number of frag- 
ments and the lines of fracture communicate with each other. 

Complicated: In addition to the fracture, a neighboring 
joint is dislocated, the main artery or nerve of the extremity 
is injured, or there is a severe laceration of the soft parts. 

Fissured : A linear split without displacement. 

Stellate : The lines of fracture radiate from a central point. 

Depressed : There is a crushing in of a portion of the bone. 

Impacted : One fragment is driven into the other. 

Apophyseal : A separation of a scale of bone to which a 
ligament or tendon is attached. 

Longitudinal, transverse, oblique, and spiral: The desig- 
nations indicate the directions of the line of fracture. 

_^ Give the general symptoms of brain tumor. 

Headache, pain upon percussion, vomiting, vertigo, epi- 
leptic convulsions, choked disc, and finally, symptoms of com- 
pression. 

Describe an operation for the cure of webbed fingers. 

Didot's operation. After all aseptic precautions have been 
observed, a flap the length of the finger and half its width 
(plus the added width of the web) is taken from the dorsal 
surface of one finger and the palmar surface of the other. 
Each of these flaps is carefully applied to the denuded area 
upon the finger to which it is attached and secured by sutures.. 

How is resection of the e!bow=joint performed? 

After all aseptic precautions have been observed, the fore- 
arm is flexed to a right angle and held across the chest of the 
patient by an assistant. A vertical incision five inches in 
length is now made along the back of the joint, the center of 
the incision being a line or two to the inner side of the tip of 



SURGERY. 423 

the olecranon. This incision goes down to the bone and di- 
vides the tendon of the triceps longitudinally. The tendon 
is then separated from the olecranon and this process cleared 
off, keeping the knife close to the bone to avoid wounding the 
ulnar nerve on the inner side and the extension of the triceps 
upon the outer side. The olecranon is now -cut through and 
removed. With the thumb in the wound to protect the soft 
parts, the structures are gradually separated from the inter- 
nal condyle by the knife (cutting towards the bone) or 
periosteal elevator. In this manner the common flexor tendon 
is separated from the bone and the internal lateral ligament 
is divided. The external condyle is now freed in a similar 
manner, and the end of the humerus is protruded through the 
wound by flexing the forearm until it touches the arm. The 
articular surface of the humerus is now sawn off, and if any 
carious areas are seen upon the surface of section they are to 
be thoroughly gouged out. The bones of the forearm are then 
forced through the wound and their cartilaginous surfaces 
removed. Care must be taken not to injure the insertions of 
the biceps and brachialis anticus. All diseased synovial mem- 
brane and granulation tissue must be dissected away, any ex- 
isting sinuses thoroughly curetted, and the parts flushed with 
an antiseptic solution. A drainage tube is inserted in the 
most dependent portion of the wound, sutures are introduced, 
and an aseptic dressing applied. 

Give the symptoms and treatment of naevus. 

Capillary naevus occurs in the form of a slightly elevated 
mass, which varies in color from purple to bright red, ac- 
cording to the relative amount of contained venous or arte- 
rial blood. These growths are congenital or occur soon after 
birth, they may be multiple, and rarely exceed an inch or two 
in diameter. They are usually found upon the neck or face. 
They may shrink .and disappear, persist unchanged, or 
rapidly increase in size. Treatment : Excision or electrolysis. 

Cavernous naevus usually involves both skin and subcuta- 
neuos connective tissue. It usually occurs as a lobulated 



424 SURGERY. 

bluish or dusky red swelling, soft to the touch, easily com- 
pressible, but refilling upon the removal of the pressure. 
Pulsation and bruit are usually absent. Treatment : Excision 
wherever practical. Electrolysis when the growth cannot 
be excised. 

What is glaucoma? Give the treatment of glaucoma. 

Glaucoma is a disease of the eye characterized by increased 
intra-ocular tension, excavation of the optic disc, restriction 
of the field of vision, corneal anesthesia, colored halos about 
lights, and diminution of visual power that may result in 
blindness. Treatment : Iridectomy. 

What is a tumor? 

A tumor is an atypical new growth which is not the result 
of inflammation. 

A tumor is an adventitious mass of tissue, differing from 
the tissue in which it grows in gross and minute structure, 
tending to unlimited growth, having no function, the nutri- 
tion of which is independent of the general nutrition of the 
body, showing no tendency to spontaneous cure, and not co- 
incident with nor dependent upon 'inflammation. 

— Describe the following forms of sutures: Interrupted, 
button, continued, buried, secondary. 

The interrupted suture consists of a number of single 
stitches, each one being independent of its neighbor. 

The button suture is made by inserting a needle threaded 
with stout silver wire at some distance from the wound, carry- 
ing it deeply through the tissues and bringing it out at a cor- 
responding point on the opposite side of the wound. The 
suture is secured at both ends to a flat lead button, the wire 
being pulled as tight as is deemed advisable. 

In a continued suture the suture traverses the wound con- 
tinuously in the same direction, being tied only at the begin- 
ning and at the end. 

A buried suture is one completely covered by and not in- 
volving the skin. 



SURGERY. 425 

Secondary sutures are those which are introduced at some 
time (usually two or three days) subsequent to an operation. 

What are the causes of atony of the bladder? 

Chronic over-distension from obstructed outflow (enlarged 
prostate, stricture), a single prolonged voluntary or involun- 
tary over-distension, cystitis (particularly when gonorrheal), 
senility, and infective fevers. 

What is the treatment of fracture united with de= 
forrnity? 

Osteotomy or osteoclasis. If the deformity is not great no 
treatment may be required. 

Give the treatment for rattlesnake bite. 

If the bite has been received upon a limb, a ligature should 
be immediately thrown around the part above the wound and 
drawn tight enough to prevent the entrance of the venom 
into the circulation. The wounded area should then be freely 
excised and bleeding encouraged for a short time. If the 
bite is upon a portion of the body which cannot be constricted 
by a ligature the wound should be excised as before, or if this 
is impracticable vigorous suction of the wound should be 
made. In the case of an extremity the ligature is to be slack- 
ened at intervals to allow of the admission of any remaining 
poison by instalments. The injection about the wound of a 
1 per cent, aqueous solution of potassium permanganate has 
been highly recommended. Antivenene may also be em- 
ployed. The constitutional treatment ^consists of the free 
administration of alcohol and hypodermatic injections of 
strychnine. 

What circumstances demand amputation of an ex= 
tremity? 

Amputation is demanded : 1. To trim up a stump of a limb 
torn off by machinery, cut off by wheels of a railway train, 
or carried away by a cannon-ball ; 2. When the entire limb or 
one of its segments has been totally disorganized; 3. Where 



426 SURGERY. 

gangrene is imminent or has supervened (particularly if it is 
of the spreading type) ; 4. When marked symptoms of sepsis 
make their appearance or exhaustion supervenes from sup- 
puration, in a case where an unsuccessful attempt has been 
made to save a doubtful limb; 5. In severe compound lacera- 
tions of the foot in old people, laying open the common syn- 
ovial cavity and involving the bones; 6. By primary malig- 
nant growths of bone (sarcoma). 

Amputation may be required for the relief of deformity, 
for the removal of benign growths ( enchondroma of fingers) , 
for laceration of the main artery of the limb, with other grave 
lesions of the soft parts, and in cases where the limb, if saved, 
would be of no practical use. 

Define the terms thrombus, phlebitis, and varix, and 
give the causes of each. 

A thrombus is a clot of blood formed within the heart or 
blood-vessels. It is due to alterations in the blood current, 
changes in the vessel-walls, and alterations in the blood itself. 

By phlebitis is meant the inflammation of a vein. It may 
be due to injury of the coat of the vein, to the formation of a 
thrombus within the vein, to the extension of an inflammation 
from surrounding tissues, to gout, or to infection with pyo- 
genic organisms. 

By varix is meant a dilated, elongated, and more or less 
tortuous condition of a vein. It is due to increased pressure 
within the veins (long standing, habitual over-exertion, tight 
garters), obstruction or occlusion of the deeper veins, and to 
an abnormal communication with an artery (aneurysmal 
varix) . Inherited weakness and the relaxation of the system 
from sedentary habits are predisposing causes. 

Describe a chancroid. Give its usual symptoms and 
possible complications. 

A chancroid is an infectious venereal sore -characterized bv 
the absence of constitutional manifestations. It commences 
as a pustule or ulcer, is frequently multiple, is round, oval,. 



SURGERY. 427 

or unsymmetrically irregular, is excavated or " punched 
out," has a rough " worm-eaten " whitish- gray surface, se- 
cretes an abundant purulent discharge which is readily auto- 
inoculable, runs an irregular course, is painful, and usually 
responds to local treatment. The possible complications are 
phimosis, paraphimosis, lymphangitis, and bubo. 

What is a dislocation? Define the various kinds of 
dislocation. 

A dislocation is a displacement of one or more bones of a 
joint from its natural position. It is also the displacement 
of any organ from its natural position. 

Traumatic, due to violence or muscular action. 

Pathologic, due to disease. 

Congenital, due to an error of development, as a result of 
which a normal relation of the bony constituents has never 
existed. (The term " congenital dislocation " is a misnomer; 
it is a congenital malformation.) 

What are the methods of controlling hemorrhage? 

Exposure to air, cold, hot water, elevation, direct pressure, 
styptics, cauterization, acupressure, forcipressure, suture, 
torsion, and ligation. 

Define hypertrophy and give the causes. 

Hypertrophy is an increase in bulk of a tissue or organ 
occurring independently of the general growth of the body 
and without any structural change of the part effected. In 
a true hypertrophy the function is increased. 

Causes: Congenital predisposition, removal of pressure, 
direct stimulation or intermittent pressure, disturbances of 
nutrition, increased functional demand, and disturbances of 
the nervous system. 

Give the surgical palliative treatment of carcinoma of 
the stomach at the pylorus. 

Gastro-enterostomy, preferably by Yon Hacker's method 
(posterior gastro-enterostomy) . 



428 SURGERY. 

Mention the causes of delayed union and give the treat= 
ment. 

The constitutional causes are general debility, osteomalacia, 
scurvy, syphilis, senility (?), pregnancy, and the cancerous 
cachexia. 

The local causes are faulty apposition, the interposition of 
fluid, muscle, or aponeurosis 'between the fragments, want of 
rest, defective blood supply, defective innervation, inflamma- 
tion on the surface of the limb, faulty treatment, and local 
affections of bone (malignant tumors, destruction of the peri- 
osteum by inflammation). 

Treatment : The removal of any local cause and the appro- 
priate remedies for the underlying constitutional disturbance. 
Change of air, tonics, regulation of the diet, and the adminis- 
tration of the mineral acids will frequently effect a speedy 
union. 

What glandular structures are most commonly affected 
in carcinoma of the anterior portion of the tongue? 

The submental lymphatic glands, the submaxillary lym- 
phatic glands, and probably those lying beneath the sterno- 
mastoid muscles. The sublingual and submaxillary salivary 
glands may also be involved. 

What are the causes of ptosis and the remedial meas= 
ures employed? 

Paralysis of the oculo-motor nerve or its supra-orbital 
branch (syphilis, rheumatism), and faulty development or 
injury of the levator palpebral 

Treatment: If due to syphilis or rheumatism the appro- 
priate constitutional treatment is to be instituted. In the 
absence of constitutional causes, operations are performed to 
increase the vicarious action of the frontalis muscles upon the 
upper lid (Panas.) Wilder folds the tarso-orbital fascia upon 
itself and establishes a firm adhesion between the fascia and 
the frontalis muscle. If the action of the levator muscle is 
not entirely lost the principles of tendon advancement and 



SURGERY. 429 

tendon resection may be employed. (Everbusch, Snellen,. 
Wolff.) 

What articular changes take place in dislocation? 
What are the general principles governing the treatment 
of dislocation? 

One or more of the ligaments and the capsule of the joint 
are torn and the mutual relations of the articular ends of the 
bones are changed. If the dislocation remains unreduced 
the cavity of the joint becomes filled with granulation tissue 
and the displaced and lacerated connective tissues become 
condensed about the head of the dislocated bone, sometimes 
forming a new capsule. Any irregularities of the dislocated 
bone become rounded off and it contracts adhesions to the 
surrounding tissues or forms a new joint by resting against 
a bony surface, its pressure stimulating the bone and peri- 
osteum to the production of an osseous ring about the point 
of contact, which possibly becomes covered with fibro-car- 
tilage. 

Principles of treatment: Relaxation of the muscles about 
the joint, the reduction of the dislocation by causing the dis- 
located bone to enter the capsule through the same rent which 
it made upon leaving it (by manipulation, or by extension 
and counter-extension), the fixation of the parts after reduc- 
tion for a sufficient length of time, and subsequent passive 
and active motion. 

Define a fracture. Give the causes, symptoms, and 
varieties of fracture. 

A fracture is a sudden solution of continuity of a bone. 

Predisposing causes: Advancing age, male sex, and di- 
seased conditions of the bone (atrophy, fragilitas ossium, 
rickets, sarcoma, secondary cancer). 

Exciting causes : Direct violence, indirect violence, and 
muscular action. 

Symptoms: A new point of motion (preternatural mobil- 
ity), crepitus, deformity from displacement, partial or com- 
plete loss of function, and signs of local trauma. 



430 SURGERY. 

Varieties: Complete and incomplete. Simple (subcutan- 
eous), compound (open), single, multiple, complicated, com- 
minuted, and impacted. Linear, stellate, longitudinal, 
transverse, and spiral. 

What diseases attack the antrum maxillae (Highmore)? 

Hydrops, empyema, benign tumors ( chrondroma, fibroma, 
myxoma, osteoma), and malignant tumors (sarcoma and 
carcinoma) . 

When do the secondary symptoms of syphilis normally 
appear? When do the tertiary symptoms appear? 

The secondary symptoms of syphilis normally appear from 
six to ten weeks after the beginning of the infecting chancre. 

Tertiary symptoms may appear within six months of in- 
fection or not for twenty or thirty years. The time of their 
appearance is largely dependent upon the treatment received 
by the patient. In some cases which have been correctly 
treated they may never make their appearance. 

Give a resume of the constitutional and the local treat= 
ment of inflammation. 

Constitutional treatment : Rest, good hygiene, proper diet, 
purgatives, emetics, arterial sedatives, diaphoretics, diuretics, 
venesection, hypnotics, narcotics, alteratives, stimulants, and 
tonics. 

Local treatment: Rest, position, heat, cold, counter-irrita- 
tion, local blood-letting (scarifications, leeches, wet cups), 
moisture, stimulants, astringents, antiseptics, alteratives in- 
cisions, surgical operations, compression, and massage. 

Differentially diagnose chancre, chancroid, and herpes 
progenitalis. 

Chancre has a period of incubation not less than ten days ; 
commences as an erosion, tubercle, papule, or ulcer ; is single, 
or simultaneously multiple ; is round, oval, or symmetrically 
irregular; is usually cup-shaped, saucer-shaped, or elevated; 
has a smooth shining red or glazed surface, and may be cov- 



SURGERY. 431 

ered by a diphtheritic membrane or scab ; has scanty, serous 
secretion which is practically never anto-inoculable ; is almost 
always indurated (cartilaginous or parchment-like), the in- 
duration being circumscribed and disappearing under appro- 
priate treatment; is accompanied by little or no pain, and 
often heals spontaneously. 

Chancroid has no period of incubation; commences as a 
pustule or ulcer; is often multiple (frequently by 'outo- 
inoculation) ; is round, oval, or unsymme trie ally irregular 
(with borders described by segments of large circles) ; is 
hollow, excavated, or punched out; has a rough, " worm- 
eaten," whitish-gray surface; has an abundant, muco-puru- 
lent secretion (readily auto-inoculable) ; is only exceptionally 
indurated (induration shades off into surrounding tissues) ; 
is painful, and runs an irregular course. 

Herpes progenitalis has no period of incubation, commences 
as a group of vesicles which may coalesce; is multiple, is 
irregular in shape (edges described by segments of small 
circles), is always superficial, has a moderate amount of 
secretion (auto-inoculable with difficulty), has no more in- 
duration than any local ulcer, is painful, and usually heals 
promptly under mild treatment. (Condensed from Keen 
and AVhite.) 

How would you diagnose and reduce a backward dis= 
location of the forearm? 

The forearm is shortened, semiflexed, and midway between 
pronation and supination. The forearm cannot be flexed 
upon the arm. The olecranon is unduly prominent behind 
the joint, and above it is a depression in which the tendon 
of the triceps may be palpated. The head of the radius may 
be detected as a globular swelling behind the external con- 
dyle. The lower end of the humerus forms a broad promi- 
nence in front of the articulation. This dislocation is dis- 
tinguished from a supracondyloid fracture by the following 
points : the olecranon is behind a line connecting the two 
condyles, the condyles do not move with the displaced ole- 



=y— ■-•! 



432 SURGERY. 

cranon, the distance between the acromion and the external 
condyle remains unaltered, and crepitus is absent. 

Reduction: The patient is seated in a chair, the surgeon 
places his foot upon the chair with his knee in the bend of 
the elbow, and presses against the lower end of the humerus, 
at the same time fixing the bones of the forearm by grasping 
them just above the wrist. When this pressure has been 
maintained for some time, the forearm is slowly and forcibly 
flexed upon the arm. By this procedure the interlocking bony 
prominences are disengaged and reduction is effected. 

What are the principal causes of tinnitus aurium? 

Acute otitis media, chronic catarrhal otitis media, chronic 
suppurative otitis media, neurosis of the auditory nerve, 
Meniere's disease, impacted cerumen, anemia, alterations in 
pressure in the labyrinth, obstruction of the Eustachian tube, 
and large doses of quinine or of the salicylates. 

What are the most approved operative procedures in 
the treatment of varicose veins of the lower extremity? 

Excision of the entire vein, excision of a number of sections 
of the vein, excision of a portion of the internal saphenous 
vein (in certain cases), and complete division and double 
ligation of all the superficial veins at the junction of the 
upper and middle thirds of the legs (Schede's operation). 



OBSTETRICS AND GYNECOLOGY. 



Describe the female reproductive organs. 

The ovaries are two small almond-shaped organs situated 
one on either side of the uterus (described below) and at- 
tached to the posterior surface of the broad ligaments. Each 
is 4 cm. long, 2 cm. broad and 1% cm. thick, and weighs 6.4 
gm. (100 grains). It consists of the oophoron or egg-bearing 
portion and the paroophoron or fibrous portion. 

The oviducts or Fallopian tubes are the trumpet-shaped 
structures attached to the uterine cornua. Each tube is about 
liyo cm. long, and surrounds the corresponding ovary. The 
outer end is the fimbriated extremity. The tube is lined with 
ciliated epithelium, which facilitates the passage of the ovum 
to the uterus. 

The vagina or organ of copulation is the passage from the 
vestibule to the cervix. It lies at an angle of 60° to the hori- 
zon. It has two walls, anterior and posterior. Its mucous 
membrane lies in folds or rugaa. 

The hymen is the fold of vaginal mucous membrane guard- 
ing the lower orifice of the vagina. 

The vulva or external genitals includes the labia majora, 
labia minora, clitoris, vestibule and mons veneris. The labia 
majora are the fleshy folds on either side of the vestibule; 
the labia minora or nymphas are the two small mucous folds 
situated within the greater lips, they unite above to form 
the prepuce of the clitoris. The latter is the analogue of the 
penis. The vestibule is the triangular space bounded above 
by the clitoris, laterally by the labia minora, and below by the 
orifice of the vagina. The mons veneris is the fleshy eminence 
above the symphysis pubis. 

28 (433) 



434 'OBSTETRICS AND GYNECOLOGY. 

Give a description of the physiology of menstruation. 

Menstruation is a periodic series of phenomena occurring 
normally every 28 days in the non-pregnant female from 
puberty to the menopause, consisting of certain symptoms 
(menstrual molimina) and a characteristic sero-sanguinolenfc 
discharge derived from the congested mucosae of the tubes 
and uterus. The process consists in a growth of the stroma 
of the uterine mucosa and a breaking down of the congested 
vessels, with consequent formation of lacunae, which rupture. 

What is the duration of menstruation and what are the 
resulting changes in the uterine mucous membrane? 

Menstruation normally lasts 3 to 4 days. It is accom- 
panied by a growth in the stroma of the uterine mucosa, or 
congestion of the vessels which rupture, and subsequent 
degeneration of the superficial layers of the mucosa. 

What is vicarious menstruation? 

A periodic discharge of blood or other fluid from the nose, 
breast, stomach, or other organ during a period of suppressed 
menstruation. 

What are the abnormalities of menstruation and give 
their etiology and treatment. 

The abnormalities of menstruation are : Amenorrhea, or 
absence of the menstrual fluid ; scanty menstruation, or insuffi- 
cient flow; menorrhagia, or excessive flow at the menstrual 
periods; metrorrhagia, or a flow between the periods; and 
dysmenorrhea, or painful menstruation. Amenorrhea results 
from anemia, chlorosis, phthisis, nervous and mental dis- 
eases, change of climate, and uterine and ovarian defects of 
development. It is treated by diet, exercise, iron, tonics, 
arsenic, and the so-icalled emmenagogues. Menorrhagia and 
metrorrhagia result f-rom endometritis, tumors, salpingitis 
and other causes of pelvic congestion, including subinvolu- 
tion after labor. They may be treated by astringents inter- 
nally, as hydrastis, ergot, oil of erigeron, thyroid extract, and 



OBSTETRICS AND GYNECOLOGY. 435 

mammary extract, or by local treatment, including curettage. 
Dysmenorrhea requires dilatation and curettement and re- 
placement of displaced organs. 

What conditions have a bearing on the time of life in 
the female when menstruation first occurs? 

Race, social development, climatic influences and predis- 
position. The average age of puberty in this country is about 
the fourteenth year. 

What is the placenta? From what is it formed, what 
is its structure, and what are its functions? 

The placenta is the essential nutritive and respiratory organ 
of the fetus. It is formed from the chorion frondosum and 
the decidua serotina, and assumes its functions by the end of 
the third month. 

Describe the development of the placenta. 

During the rapid development of the chorion frondosum, 
or hairy chorion, a corresponding change takes place in the 
decidua serotina; its tissues hypertrophy and become thick, 
spongy and very vascular. The chorionic villi sink deeply 
into this pulpy mass and become intimately connected with it, 
permitting of osmosis or interchange of the maternal and 
embryonic blood. By the third month these structures have 
developed into the fully formed placenta. 

What are the functions of the placenta? 

1. The supplying of nourishment from the mother to the 
fetus. 2. The oxygenation of the impure fetal blood. 3. 
The excretion of the effete products from the fetus. 

Describe the human uterus and give its anatomic 
relations. 

The uterus is a hollow muscular organ situated in the cen- 
ter of the pelvis and embraced between the folds of the broad 
ligaments. It is 7^g cm. long, 4 cm. broad, and 2% cm. thick; 
it weighs 31 grams (7 drams). The upper portion above the 



436 OBSTETRICS AND GYNECOLOGY. 

point of entrance of the Fallopian tubes is the fundus, the 
portion between the tubes and the internal os is the body 
proper, and that between the internal and external os is the 
cervix. The flattened anterior surface is in close juxtaposi- 
tion with the bladder ; the posterior surface is separated from 
the rectum by Douglas' pouch or cul-de-sac. The cavity of 
the uterus measures 6% cm. (2% in.). 

How is the uterus supplied with nerves? 

The uterus is supplied by filaments from the hypogastric 
and ovarian plexuses of the sympathetic nervous system. 

Describe the normal non=gravid uterus, giving its func= 
tion and relation to the other organs of generation. 

The uterus has already been described. It lies above the 
vagina, its axis being at right angles to the axis of the vagina. 
The tubes are continuous with the cornua, and extend one to 
either side of the fundus. The ovaries are one either side of 
the uterus below the tubes. 

Describe the semen. 

The semen is a thick, viscid, yellowish or opalescent fluid, 
with a faint characteristic lime-like odor, secreted by the tes- 
ticles and prostate gland. Its most important constituents 
are the spermatozoids. 

Define insemination and state the conditions necessary 
to its accomplishment. 

Insemination is the deposit of the semen within the vagina 
during copulation. It is not necessarily followed by impreg- 
nation. 

What are spermatozoa? Where are they found? De= 
scribe their appearance and function. 

The spermatozoa are microscopic, tadpole-like bodies pres- 
ent in immense numbers in the semen. They are about 1-500 
of an inch in length, and are derived from the sperm-cells of 
the seminal tubules of the testicles. They have flat, oval 



OBSTETRICS AND GYNECOLOGY. 437 

heads, small bodies, and immensely elongated flagella or tails, 
which are in constant motion. Their function is fertilization 
of the ovum. 

Give the definition, physiology and frequency of ovula= 
tion and state whether ovulation and menstruation are 
synchronous. 

Ovulation is the formation, development and discharge of 
a mature ovum from the ovary. It occurs once or twice in 
a month, and is not necessarily synchronous with menstru- 
ation. 

What is the mechanism of the escape of the ovule and 
its transmission to the tubes and uterus? 

Upon the establishment of puberty certain Graafian folli- 
cles assume extraordinary growth, and rapidly approach the 
ovarian surface. Owing to the increased intrafollicular pres- 
sure the capsule yields and the contents — an ovum and the 
liquor folliculi — escape. The ovum is received into the Fal- 
lopian tube either by direct introduction at the time of rupture 
or by suction, and is then carried into the uterine cavity by 
the action of the ciliated epithelium of the tube. 

Define fecundation and describe its physiology. 

Fecundation is the fertilization of the ovum by the sper- 
matozoids. It is accomplished according to some in the tubes 
or on the ovarian surface, and according to others in the 
uterine fundus. The spermatozoids penetrate the vitelline 
membrane of the ovum through the micropyle. The ovum 
then undergoes a series of progressive changes. 

Give the successive changes that take place in the ovum 
after fecundation, and during its passage to the uterus. 

1. Absorption of the vibratile extremity of the spermato- 
zoid, leaving the head only, which is known as the male pro- 
nucleus. 2. Union of the male and female pronuclei to form 
the oosperm or blast ospliere. 3. Division of the vitelline nu- 
cleus, followed by segmentation of the vitellus, resulting in 



438 OBSTETRICS AND GYNECOLOGY. 

the formation of the morula or mulberry mass. 4. Appear- 
ance in the center of the morula of a transparent fluid, which 
condenses the morula into a thin cellular layer (blastoderm 
or blastodermic membrane). 5. Division of the blastoderm 
into the epiblast, mesoblast and hypoblast. 6. Aggregation 
of the hypoblastic cells into the germinal or embryonic area. 

7. Appearance in this of the primitive trace or embryonic 
line, surrounded by a translucent space, the area pellucida* 

8. Incurving of the extremities of the primitive trace to form 
the fetal ellipse. 9. Development of the embryonal parts. 

Describe the vitellus, the allantois, and the amnion. 

The vitellus is the protoplasmic yelk of the ovum. The 
allantois is a small pear-shaped vesicular structure which 
develops from the lower portion of the embryonic alimentary 
canal at about the 20th day of intra-uterine life. It is a vas- 
cular structure, and is the forerunner of the placenta. It is 
intimately associated with the chorion. The amnion is a 
smooth, tough, transparent, glistening, fibrous structure, the 
innermost of the fetal membranes, surrounding the fetus and 
continuous with it at the umbilicus; it secretes and encloses 
the liquor amnii. 

Describe the fully developed ovum. 

The ovum is the vital element or reproductive cell of the 
female. It varies in size from 1-500 to 1-120 of an inch. It 
consists of a protoplasmic yelk or vitellus and a nucleus or 
germinal vesicle (vesicula germinativa) enclosed within a 
hyaline covering, the zona pellucida or vitelline membrane. 

What is the character of the liquor amnii and what are 
its sources and uses? 

The liquor amnii is an algaline fluid, about a quart in 
quantity, with a light specific gravity, an opaque white color, 
and a characteristic odor. It prevents undue pressure of the 
uterine walls upon the fetus, it saves the uterus from injury 
due to the fetal movements, it maintains an equable temper- 



OBSTETRICS AND GYNECOLOGY. 439 

ature around the fetus, and it receives and dilutes the excre- 
tions of the fetus. It is derived from the fetus largely, and 
contains much fetal urine. 

What is the umbilical cord and how is it formed? 

The funis or umbilical cord is a cord-like structure extend- 
ing from the umbilicus of the fetus to the placenta. It is 
developed from the pedicle of the allantois at about the fourth 
week of pregnancy. It measures at term about 50 cm. in 
length. 

What structures compose the fully developed umbilical 
cord? 

Two umbilical arteries, one umbilical vein, the vitelline 
duct, the pedicle of the allantois, and the jelly of Wharton. 

What are uterine hydatids (hydatid pregnancy)? What 
are their source and treatment? 

This is an unusual name for hydatidiform mole or cystic 
disease of the chorion, a rare affection of the chorion consist- 
ing in a proliferative degeneration of the chorionic villi with 
the production of a mass of grape-like vesicles attached to the 
placenta. The disease occurs about once in 2000 cases of 
pregnancy. The treatment consists in immediate evacuation 
of the uterine contents. 

What changes take place in the female at puberty? 

Hair appears above the pubis ; the breasts develop ; the 
function of ovulation is established; menstruation appears; 
the pelvis widens ; and there is a growth of the sexual sense. 

What are the differences between the male pelvis and 
the female pelvis? Give the importance of the female 
characteristics in labor. 

Male. Heavy structure. Cavity deep and contracted. 
Sacrum narrow and slightly curved. Ischial tuberosities 
closely approximated. Subpubic angle 75°-80°. Pelvic brim 
triangular. Slight pelvic inclination. Thyroid foramen 
oval. 



440 OBSTETRIC 8 AND GYNECOLOGY. 

Female. Light structure. Cavity shallow but roomy. 
Sacrum wide and deeply curved. Ischial tuberosities widely 
separated. Subpubic angle 90°-100°. Pelvic brim cordate. 
Great pelvic inclination. Thyroid foramen triangular. 

The female characteristics favor ready transit of a fetus 
through the pelvis. 

Give the bones, divisions, straits and symphyses of the 
obstetric pelvis. 

The pelvis is composed of the two innominate bones, the 
sacrum and the coccyx ; it is divided into the true pelvis below 
and the false pelvis above the iliopectineal line. This line 
forms the boundary of the inlet or superior strait. The lower 
orifice is the inferior strait. The symphyses are three in num- 
ber, viz., the pubic, and the two sacro-iliac synchondroses. 

Give the obstetric landmarks of the superior and infe= 
rior straits. 

Superior strait. The four cardinal points, viz., the sacro- 
iliac synchondroses, and the iliopectineal eminences; also the 
promontory of the sacrum, and the iliopectineal line. Infe- 
rior) strait. The tips of the coccyx, the ischial tuberosities, 
and the subpubic angle. 

Give the names and dimensions of the diameters of the 
pelvic inlet. 

The conjugate or anteroposterior, 11cm. ; the transverse, 
13% cm., and the two oblique diameters (between one ilio- 
pectineal eminence and the opposite sacro-iliac synchon- 
drosis), 12% cm. 

What are the diameters of the pelvic outlet? How is 
the pelvic outlet bounded? 

The transverse (between the ischial tuberosities) 11 cm., 
and the conjugate (between the tip of the 'coccyx and the sub- 
pubic ligament) 9y 2 cm. at rest, and 11 cm. in labor. The 
pelvic outlet is bounded by the tip of the coccyx, the ischial 
tuberosities, the sacrosciatic ligaments, the thyroid foramina, 
and the subpubic ligament. 



OBSTETRICS AND GYNECOLOGY. 441 

Differentiate the planes and axes of the pelvis and men= 
tion their obstetric importance. 

The plane of the superior strait forms an angle of 50°-60° 
with the horizon ; the plane of the inferior strait forms a line 
of 10° with the horizon. The roomiest portion of the pelvic 
cavity forms what is known as the plane of pelvic expansion, 
while the narrowest portion of the cavity forms the plane of 
pelvic contraction. The axis of the pelvic cavity, known as 
the curve of Cams, extends from the middle of the plane 01 
the superior strait to the middle of the plane of the inferior 
strait, and follows the curve of the sacrum. The greater its 
curvature, the more difficult the labor; also the greater the 
pelvic obliquity, the more difficult the labor. 

What are the varieties of deformed pelvis? 

The most commonly recognized varieties are the simple 
flat, the spondylolisthetic, the rachitic, the coxalgic, the sco- 
liotic, the osteomalacic, Naegele's, Robert's, the kyphotic, the 
kyphoscoliotic, the justo-minor, the generally contracted and 
flat, the justo-major, the split pelvis, and the pelves distorted 
by tumors and fractures. 

What difficulties arise during labor from malformations 
of the maternal pelvis? 

If the pelvis be increased in size a precipitate labor will 
probably result. If it be contracted there will occur all de- 
grees of obstruction, from the slightest retardation to total 
blocking of the fetal progress. This will result in increased 
severity of the labor pains, rise of the contraction-ring, early 
escape of the liquor amnii, serious compression of the fetal 
head, malpositions and malpresentations of the fetus, and 
sloughing of the maternal soft parts. 

What varieties of deformed pelvis are liable to inter= 
fere with obstetric procedures? How? 

All pelves that are contracted in the superior or inferior 
straits will more or less seriously obstruct labor. This in- 



442 OBSTETRICS AND GYNECOLOGY. 

eludes the vast majority of deformed pelves, whatever the 
cause of the deformity. 

Describe and differentiate justo=minor pelvis and justo= 
major pelvis, and state how each may complicate labor. 

The justo-minor pelvis is one equally contracted in all of 
its diameters; it is normal in shape, but undersized. The 
justo-major pelvis is one equally enlarged in all its diameters. 
The former obstructs labor ; the latter predisposes to precipi- 
tate labor. 

Describe a nonrachitic flat pelvis, and give the man= 
agement of labor in such a condition. 

This is a very common form of pelvic deformity, consisting 
in a diminution in the anteroposterior diameter of the supe- 
rior strait of the pelvis without any disturbance in the size of 
the other diameters. As a rule, it does not result in serious 
interference of labor, although instrumental delivery may be 
required. 

What structures enter into the formation of the pelvic 
floor? 

From without inward the muscles of the pelvic floor are the 
transversus peronei, the ischiocavernosus, the sphincter ani, 
the sphincter vagina?, the coccygeus, and the levator ani mus- 
cles, together with the pelvic fascia and the perineal wedge 
or body. 

What changes occur in the uterus during pregnancy? 

There is a general hypertrophy of all the uterine tissues, 
especially of the muscular substances. The blood-vessels are 
increased in number, size, length and tortuosity. The veins 
lose all their coats but the intima, The uterus slightly ro- 
tates on its axis from left to right during its development. 

What are the effects of pregnancy on the maternal 
organisms? 

In addition to the uterine changes already described there 
will be noted the following: A deposit of fat in the abdominal 



OBSTETRICS AND GYNECOLOGY. 443 

wall, an edema of the joints of the pelvis, congestion of the 
pelvic viscera, an increase in the quantity of blood and of the 
urine, alterations in taste and disposition, and a softening of 
the hones of the entire body. 

What changes occur during pregnancy in the external 
genitals and vagina? 

There will be noted an increased vascularity, with edema 
and softening of the tissues, and bluing of the mucous. mem- 
brane. 

What changes occur in the breasts during pregnancy? 

The breasts become enlarged generally and much engorged, 
and a deposit of pigment takes place in the areola. This pri- 
mary ring of pigment may be surrounded by a secondary 
areola of light color. The glands of Montgomery become 
enlarged and protuberant. The nipples become prominent, 
and colostrum develops in the mammary glands. 

What changes occur in the blood during gestation? 

The general quantity of the blood is increased, while its 
quality decreases ; in other words, there exists a combined 
hydremia and anemia. There is an increased tendency to 
clot from the large amount of fibrinogen present- 
Describe the human embryo during the second month, 
during the fifth month, during the seventh month, and 
during the ninth month, giving size and weight. 

At the second month the embryo is the size of a pigeon's 
egg; the visceral clefts are closed; the head forms more than 
two-thirds of the embryo, and all its features may be distin- 
guished; the hands and feet are webbed; the length of the 
fetus is 4 cm. (1% inches) ; its weight is 4 grams (60-62 
grains). 

At the fifth month the face is wrinkled and senile, the hair 
and nails are fully formed, the vernix caseosa appears, the 
eyelids begin to open; the umbilical cord is about 12 inches 
long; the length of the fetus is about 25 cm. (9% inches) ; 
its weight 273 grams (10 8-10 ounces). 



444 OBSTETRICS AND GYNECOLOGY. 

At the seventh month the skin is still wrinkled and reddish, 
the lanugo begins to disappear from the face, the eyelids are 
open, the membrana pupillaris disappears ; the length of the 
fetus is 35 cm. (13% inches) ; its weight 1213 grams (39 
ounces) . 

At the ninth month the senile appearance of the face dis- 
appears, the lanugo begins to disappear from the body; the 
length of the fetus is 45 cm. (17% inches) ; its weight 1990 
grams (5% pounds). 

Name the diseases of the fetus and its membranes in 
utero. 

The fetus may suffer from various infectious diseases trans- 
mitted to it through the placental circulation ; rarely it may 
develop tuberculosis in this way; fetal rickets is a common 
condition, as is also fetal syphilis ; very rarely the fetus may 
develop tumors in various portions of the body; maternal 
impressions may be noted; and various intracranial diseases, 
as meningocele, hydrocephalus and the like; fetal ichthyosis 
is rarely noted. The diseases of the membranes include 
hydramnios, oligohydramnios, and cystic disease of the cho- 
rion. 

How would you diagnose the death of the fetus in utero? 

In about the order of value the signs of fetal death are : 1. 
Cessation of abdominal and uterine growth, followed by sub- 
sidence in the size of the uterus. 2. Subsidence of the signs 
of pregnancy. 3. Absence of fetal heart-sounds and fetal 
movements. 4. Absence of pulsation in the umbilical cord or 
fetal precordium. 5. Decrease in the cervical temperature. 
6. Appearance of milk in the breasts (occasional). 7. Pep- 
tone or acetone in the urine. 8. Cranial crepitus in case of 
maceration of the fetus. 

How may death of the fetus in utero be recognized after 
the period of viability? What should be done in such 
cases? 

Fetal death may be presupposed by a suppression of all 



OBSTETRICS AND GYNECOLOGY. 445 

the signs of pregnancy that have been present; by absence 
of the fetal heart-sounds; by cessation of the growth of the 
abdomen, with subsequent diminution in the size of the 
abdominal girth, and occasionally by the appearance of milk 
in the breasts. "When fetal death is assured the uterine con- 
tents should be removed. 

Give the obstetric anatomy of the fetal head. 

The fetal head at term consists of the two frontal bones,, 
the two parietal bones, the occiput and the bones of the face. 
These various bones are separated by sutures, as follows; 
The frontal, the sagittal, the coronal, the lambdoid, and by 
the two fontanels, the anterior and the posterior. 

Name the various diameters of the fetal head. 

The diameters of the fetal head are as follows : The bitem- 
poral, 8 cm. ; the biparietal, between the two parietal emi- 
nences, 914 cm. ; the bimastoid, between the two mastoid 
processes, 7^s cm. ; the occipitofrontal, from the root of the 
nose to the external occipital protuberance, 11% cm. ; the 
oecipito-mental, from the point of the chin to the external 
occipital protuberance, 13% cm. ; the suboecipito-bregmatic, 
from the central point of the bregma to a point midway be- 
tween the occipital protuberance and the foramen magnum,. 
9% cm. ; the f rontomental, from the top of the forehead to the 
point of the chin, 8 cm. ; the trachelo-bregmatic, from the 
central point of the bregma to the anterior margin of the 
foramen magnum, 9% cm. ; and the mento-bregmatic or 
cervico-bregmatic, from the central point of the bregma to 
the junction of the chin and neck, 9% cm. 

Describe the fontanels and their diagnostic uses. 

The anterior or larger fontanel or bregma is a diamond- 
shaped space left at the point of junction of the frontal, 
coronal and sagittal sutures. The posterior or smaller fon- 
tanel is situated at the point of junction of the lambdoid and 
sagittal sutures, and is triangular in shape. It is felt in all 



446 OBSTETRICS AND GYNECOLOGY. 

normal vertex presentations, and by its situation determines 
the position of the head in labor. The bregma is never felt 
in a normal presentation, but may be palpated in the presen- 
tation of the top of the head, in a brow presentation, and in 
presentation of the occiput in the hollow of the sacrum. 

What is meconium and what are its diagnostic relations? 

Meconium is the peculiar greenish substance contained in 
the fetal bowels at birth. If it be discharged prior to the 
delivery of the child, it generally indicates a breech pre- 
sentation. Occasionally it will escape in difficult head- 
deliveries. 

Describe the fetal heart=sounds, give their rate, and 
state when and where they are best heard. 

The fetal heart-sounds constitute an absolute sign of preg- 
nancy from the sixth month of gestation on. They resemble 
the ticking of a watch under a pillow ; their rate is about 
twice that of the maternal heart-beat, averaging from 120 to 
160 beats a minute. The position of maximum intensity 
varies according to the fetal presentation. In anterior ver- 
tex presentations they are best heard at a point midway be- 
tween the umbilicus and the anterior spinous process of that 
side upon which the fetus is resting, while in posterior vertex 
presentations the point of maximum intensity would be in 
the corresponding flank, slightly below a transverse line pass- 
ing through the umbilicus. 

What is ballottement, and how is it performed? 

Ballottement is a balancing of the fetus in utew between 
the fingers of the two hands. In vaginal ballottement the 
index and middle fingers of the left hand are inserted into the 
anterior vaginal fornix, the patient lying in the dorsal posi- 
tion, while the fundus is steadied by the right hand placed 
upon the abdomen. The vaginal fingers give ia sudden im- 
pulse to the anterior uterine wall, whereby the fetus is dis- 
placed upward ; the latter gently falls back and strikes upon 



OBSTETRICS AND GYNECOLOGY. 447 

the propelling fingers. This sign is positive, and is available 
from the middle of the fourth to the eighth months. 

How would you diagnose pregnancy at five months, at 
or before the end of the third month, and at full term? 

In the first three months of pregnancy the following signs 
are present: Menstrual suppression, nausea and vomiting, 
and the four soft signs, viz., Groodell's sign (softened cervix), 
Hegar's sign (softened lower uterine segment), the soft, and 
boggy uterine body, and the soft and enlarged mammae, with 
the darkened areolae. 

At the fifth month there will be added to the foregoing 
Jaequemin's sign (the bluing of the vaginal and vulvar 
mucosae), Braxton Hicks' intermittent uterine contraction, 
ballottement, and quickening; the uterus will also be con- 
siderably more enlarged. 

At term all the foregoing signs are present, save balMte- 
ment, and in addition the fetal heart-sounds may be detected, 
and palpation will reveal the fetal outlines both above and 
below. 

What are the subjective signs of pregnancy? 

The subjective signs of pregnancy are those recognized by 
the patient herself. This includes menstrual suppression, 
nausea and vomiting, vesical irritability, quickening, pain in 
the abdominarwalls from excessive distension, vertigo, palpi- 
tation, and gastric disturbance. 

What signs of pregnancy are determined by the touch? 

The four "soft signs," the fetal parts and presentation, 
ballottement, Braxton Hicks' sign, the uterine enlargement, 
and the fetal movements. 

What may be learned by abdominal palpation of the 
pregnant woman after the eighth month? 

The fetal movements, the fetal parts, the position and pre- 
sentation of the fetus, the size and position of the uterus, the 
degree of distension of the uterine and abdominal walls, the 
size of the pelvic inlet, the movability of the fetal head. 



448 OBSTETRICS AND GYNECOLOGY. 

Classify the objective signs of pregnancy and state their 
relative value. 

The five positive signs of pregnancy are ballottement, fetal 
movements, fetal heart-sounds, blue discoloration of the vulva 
and vagina, and intermittent uterine contractions. Other 
valuable objective signs are cervical softness (in primparae), 
Hegar's softening of the lower uterine segment, darkening 
of the areolae of the breasts, the presence of colostrum in the 
breasts, and the outlining of the fetal parts. 

What are the signs of pregnancy, doubtful, probable, 
and certain? 

The doubtful signs of pregnancy are vesical irritability, 
irregular gastric disturbances, increasing constipation, dimin- 
ution but not actual suppresson of the menstrual flow, all 
occurring in a woman exposed to the possibility of impreg- 
nation. 

The probable signs are total menstrual suppression, in- 
creasing size of the uterus, darkening of the mammary 
areolae, development of Montgomery's tubercles, and fre- 
quency of micturition. 

The certain signs are the positive signs already enumerated. 

What is to be learned by abdominal auscultation in 
pregnancy? 

Auscultation of the abdomen will reveal the placental 
souffle or uterine bruit and the fetal heart-sounds. Occasion- 
ally the umbilical souffle may be detected. 

Describe the changes in position which the uterus un= 
dergoes during pregnancy. 

At first the uterus sinks into the pelvis on account of its 
increased specific gravity. There then follows a gradual and 
progressive rise into the abdomen until 2 to 4 weeks before 
term, when a secondary sinking (lightening) occurs, due to 
the entrance of the fetal head into the superior strait. 



OBSTETRICS AND GYNECOLOGY. 449 

At what period does quickening usually occur? 

In the middle of the fifth month of gestation. 

How should external palpation of the pregnant woman 
be performed? 

The woman lies in the dorsal position with the limbs partly 
flexed. General pressure is made with the tips of the fingers 
and the ulnar borders of the palms upon the abdominal sur- 
face from the median line towards the flanks. The hands 
are permitted to dip beneath the central points of Poupart's 
ligaments and beneath the pelvic brim in order to determine 
the fetal presentation. 

What is " morning sickness," when does it begin, how 
long does it usually continue, and what is its causation 
and treatment? 

The nausea and vomiting of pregnancy occurs usually at 
the sixth week of gestation, and normally lasts for six weeks. 
It may begin earlier or it may not appear at all. It is be- 
lieved to be due to a reflex irritation of the nerve-endings in 
the uterus resulting from the rapid growth of that organ. 
It is best treated by the exhibition of nerve-sedatives, such as 
sodium bromide, ingluvin, oxalate of cerium and the like. 

Differentiate ordinary morning sickness from the hy= 
peremesis of pregnancy. Mention the causes and de= 
scribe the management of the latter. 

The pernicious vomiting of pregnancy is an exaggerated 
gastric disturbance which appears to become uncontrollable, 
and may result fatally from extreme prostration. It is due 
to a number of conditions, including the presence of toxins 
of undetermined nature in the blood, probably resulting from 
imperfect functionating of the liver. It occurs in women 
whose uteri have been chronically diseased, and in those who 
are of a neurotic tendency. It may also result from kidney- 
failure, and from too frequent sexual intercourse. Its treat- 
ment consists in proper hygiene, the correction of uterine 
29 



450 OBSTETRICS AND GYNECOLOGY. 

displacements or cervical catarrh, restriction in diet, the use 
of proper therapeutic measures, and, if need 'be, rectal ali- 
mentation. The pregnancy should he terminated if the other 
measures fail. 

What is the normal duration of pregnancy? What are 
the limits of the variations, and how should its duration 
be calculated? 

From a number of investigations it has been found that in 
the human being pregnancy normally covers 280 days (10 
lunar or 9 calendar months). It may be extended up to 302 
days and pregnancy still be considered legitimate. Fre- 
quently the pregnancy terminates prematurely, and this may 
happen at any time subsequent to conception. The methods 
of determining the date of confinement are numerous. The 
Naegele rule is to count back 3 months from the date of the 
appearance of the last menstruation and add 7 days. The 
date of quickening usually occurs midway through gestation, 
or at 4% months. Other methods consists in mensuration of 
the uterus and of the fetus, and the use of periodoscopes and 
tables. 

How would you differentiate between the first and 
subsequent pregnancies? 

In a primipara the fourchet is present; it is missing in a 
multiparous woman. The abdominal walls are relaxed and 
marked with striae in the multipara, while in the primipara 
the abdomen is full, rounded and tense. The nipples are 
large and well developed in the multiparous woman, and 
usually small and undeveloped in the primipara. 

Given a distended abdomen, how would you differen= 
tially diagnose pregnancy, ovarian disease, ascites, and 
gaseous accumulation? 

In ovarian cyst there is generally an absence of the chief 
signs of pregnancy; the characteristic ovarian facies is pres- 
ent; the abdominal tumor is soft, fluctuating, usually more 
or less directed to one side, and does not reveal the fetal signs ; 



OBSTETRICS AND GYNECOLOGY. 451 

^continuance of menstruation is the rule; the cervix is not 
unduly soft; and the history is obscure, the growth slowly 
developing for a longer period than the full term of gestation. 

In ascites percussion shows dulness in the flanks, with re- 
sonance in the median abdominal line, the area of dulness 
changing with the position of the patient; there is free fluc- 
tuation; the usual signs of pregnancy are absent; the abdo- 
men is flattened in the umbilical region, with bulging at the 
sides; the umbilicus is always depressed; palpation does not 
reveal any definite tumor; the cervix is not altered. 

In gaseous accumulation or pseudocyesis, which most com- 
monly occurs in elderly women at or near the menopause or in 
young or hysterical women, some of the important signs of 
pregnancy will be absent; the uterus is not enlarged, and the 
cervix is not soft; there is a tympanitic percussion-note over 
the whole abdominal surface, and if the patient be anesthe- 
tized the abdominal enlargement will disappear entirely. 

Differentiate uterine bruit and umbilical souffle. 

The uterine bruit or placental souffle is a rhythmic blowing 
-sound occurring synchronously with the maternal heart-beat. 
It is first heard about the beginning of the fourth month, and 
is generally located low down and to one or the other side of 
the uterus. It is also known as the placental murmur. The 
umbilical or funic souffle is a peculiar high-pitched hissing 
sound heard most distinctly in the immediate vicinity of the 
fetal heart, with the beat of which it is synchronous. It is a 
sign of fetal danger, and indicates some stenosis of the um- 
bilical arteries. 

Describe the mammary glands and the changes they 
undergo in pregnancy. When the child is stillborn what 
care should be taken of the mother's breasts? 

The mammary glands are two large glandular structures 
on the anterior surface of the thorax. They consist of a num- 
ber of lobules, each of which has an excretory or galacto- 
phorous duct which runs to the nipple. During pregnancy 



452 OBSTETRICS AND GYNECOLOGY, 

the breasts enlarge and become firm and heavy. Glistening 
streaks appear upon the surfaces from over-distension. Pig- 
ment is deposited around the nipple in the areolae ; the glands 
of Montgomery enlarge and protrude from the surface; the- 
nipples increase in size and become prominent and protrud- 
ing. Colostrum appears in the breast after the third month. 
If the child is still-born the breasts must be strapped and 
applications made to prevent the development of milk. 

State the medicolegal complications that may arise 
from an erroneous diagnosis of pregnancy. 

An erroneous diagnosis of pregnancy may result in con- 
jugal unhappiness, with divorce; it may cause the execution 
of an innocent woman or unnecessary confinement in prison ; 
it may alter the terms of a will or the dividing of an estate ; 
it may bring a law-suit against the physician. 

What are the positions and attitudes of the fetus in 
utero, and what are their causes? 

The fetus may lie parallel with or at right angles to the 
long axis of the woman's body; it always lies in the long axis 
of the uterus, whether this be horizontal or vertical. It may 
lie obliquely if there exist a tumor or thickening in the uterine 
wall, of if the uterine cavity be irregular in its outlines. 

How many different presentations are liable to be met 
in obstetric practice? What are they? 

There are three presentations of the fetal body, viz., the 
cephalic or head, the pelvic, and the transverse or trunk. 
The cephalic presentations include the vertex, face, bregma 
or anterior fontanel, brow, ear, and parietal eminence. The 
pelvic presentations include the breech, knee, and foot. 

How is a vertex presentation recognized by palpation? 

Examination of the abdomen shows the hard cephalic ex- 
tremity of the child at the pelvic brim; vaginal examination 
reveals the depressed occiput and smaller fontanel at one 
extremity of a pelvic diameter, while the sagittal suture 
extends obliquely from them in the line of the diameter. 



OBSTETRICS AND GYNECOLOGY. 453 

Differentiate the positions of the fetus at term as deter= 
mined by external palpation. 

Cephalic or head presentations show the fetal ellipse lying 
longitudinally, with the fetal 'back to one or the other side 
and the hard cephalic extremity at the pelvic brim; fetal 
movements are felt high np on the abdominal surface. In 
pelvic presentations the conditions are reversed, the head 
above and the breech below; the head may be freely moved, 
and the fetal movements are felt low down on the abdominal 
surface. In transverse presentations the long axis of the 
fetus lies at right angles to the long axis of the mother's body ; 
both extremities of the fetal ellipse may be readily palpated. 

How may the knee be distinguished from the elbow 
when presenting? 

The knee is round and large, the elbow small and more 
angular; the elbow shows sharp bony processes to the sides 
and posterior; the popliteal space may be felt behind the 
knee ; the arm may readily be brought down if the elbow is 
present; the leg is brought down with more difficulty. 

What is understood by the hygiene of pregnancy? In 
a case of pregnancy how is the health of the patient main= 
tained? 

By the hygiene of pregnancy is meant the management of 
the patient according to the rules of health. This includes 
regulation of the diet, clothing, exercise, bathing and douch- 
ing, and sexual intercourse; attention to the kidneys and 
other emunctories; the correction of constipation and proper 
occupation for the mind. 

Describe the proper management of the breasts of the 
mother before labor. 

Proper development of the nipples should be favored by 
judicious manipulation daily. The nipples should be kept 
clean by soap and water and a weak solution of sodium borate. 
If the breasts are painful they may be anointed at night with 
^cocoa-butter or lanolin. 



454 OBSTETRICS AND GYNECOLOGY. 

What is the pathology of pregnancy? Name some of 
the diseases to which pregnancy predisposes. 

The pathology of pregnancy includes a study of the dis- 
eases to which a pregnant woman is exposed. The diseases 
she is most apt to develop are renal insufficiency, Bright 's 
disease, gingivitis, salivation, pica, indigestion, pernicious, 
vomiting, constipation, hemorrhoids, jaundice, appendicitis, 
dyspnea, cardiac palpitation, hydremia, pernicious anemia, 
varicose veins, hemorrhage, uterine displacements, insanity, 
neuralgias, and osteomalacia. 

To what form of morbus Brightii are pregnant women 
most liable? How would you diagnose and treat it? 

To acute nephritis, catarrhal or interstitial in nature. It 
is frequently so called when in reality the kidney of preg- 
nancy is meant. 

Give the etiology, symptoms and management, as best 
understood and practiced at present, of albuminuria of 
pregnancy. What is the prognosis? 

By the albuminuria or kidney of pregnancy is meant a 
peculiar condition manifested by a certain proportion of 
pregnant women in which albumin appears in the urine in 
varying amounts, but which is unassociated with any grave 
organic change in the kidneys. The condition is one of hemic- 
intoxication, the poisons probably originating in an imper- 
fect metabolism on the part of the liver. The poisons irritate 
the kidneys, producing an arteriole contraction, whereby the 
kidneys appear pale and anemic, and become inadequate to 
perform the work devolved upon them. The treatment of 
renal inadequacy consists in a careful supervision of the 
condition of the urine, and appropriate dietetic, hygienic and 
therapeutic regimen. Milk diet or light diet, large draughts 
of Poland or lithia water, diuretics, laxatives, alteratives, 
Basham's mixture, irrigation of the bowel with hot normal 
saline solutions, and the bromides and chloral hydrate consti- 
tute the treatment. If the disease progresses labor may have 
to be induced. The prognosis is always anxious. 



OBSTETRICS AND GYNECOLOGY. 455 

How would you measure the severity of interstitial 
nephritis in a pregnant woman, and how would you treat 
such a condition? 

By the early appearance of the symptoms, by the number 
and nature of the urinary casts, by the development of albu- 
minuric retinitis, and by the rapidly increasing edema. The 
disease requires an early evacuation of the uterine contents. 

What is the cause of difficult and painful urination in 
pregnancy? 

"When present this generally results from uterine displac- 
ment backward, the cervix tilting up against the base of the 
bladder and interfering with, micturition. 

How do uterine displacements originate, and how do 
they influence conception and pregnancy? 

Uterine displacements are generally the result of previous 
labors, the floor being lacerated and the uterus remaining 
subinvoluted and heavy. Such an organ falls back into the 
hollow of the sacrum. Anteflexion of the uterus may result 
from a ventrofixation. Any fixed displacement is apt to pre- 
vent conception by rendering the ingress of the spermatozoids 
impossible, and if pregnancy results and the displacement 
persists, abortion is apt to occur spontaneously. 

What uterine displacement is especially liable to inter= 
rupt pregnancy, and what should be done to prevent it? 

Retrodisplacement. Such a displaced uterus should be 
replaced at once, and a pessary introduced and retained until 
the fundus rises above the sacral promontory (fourth month) ; 
it may then be withdrawn. 

What treatment would you advise for a case of con= 
tinued menstruation during pregnancy? 

Such a condition indicates failure of union between the 
decidua vera and decidua reflexa. The patient should be 
kept quiet, especially at the menstrual epochs. No local 
treatment is indicated as a rule. If the hemorrhage becomes 



456 OBSTETRICS AND GYNECOLOGY. 

profuse the treatment of threatened abortion must be insti- 
tuted. 

Name the diseases of the endometrium, and state their 
effects in pregnancy. 

Inflammation (endometritis), acute or 'chronic, will tend 
to produce abortion. Chronic endometritis, especially if 
syphilitic in origin, is probably the most common cause of 
abortion. Atrophy of the decidua (hypertrophied endome- 
trium) causes the ovum to drop in the uterine cavity, and 
may result in placenta prasvia. A catarrhal endometritis 
may cause an accumulation of fluid between the layers of the 
decidua, producing the condition known as hydrorrhea gravi- 
darum, or "false waters." Apoplexy of the decidua may 
destroy the ovum. Tumors may form in the decidua rarely; 
if benign they are known as benign deciduomata; malignant 
deciduoma is rarely encountered. 

What diseases of the mother are liable to injure the 
fetus in utero? 

Syphilis, tuberculosis, rickets, the exanthemata, renal in- 
adequacy, puerperal eclampsia; any disease causing stagna- 
tion in the circulation, as chronic valvular disease and spas- 
modic maternal affections, as bronchitis, chorea and the like. 

Mention some of the principal causes of sterility in 
woman, and state how fertility may be promoted. 

Stenosis of the cervical canal from anteflexion, retrodis- 
placement of the uterus, cervical catarrh with profuse acrid 
leukorrhea, chronic salpingitis resulting in occlusion of the 
Fallopian tubes, and chronic endometritis. Rapid progressive 
dilatation of a stenosed canal, replacement of a displaced 
uterus, the local treatment of cervical catarrh and uterine 
disease will do much to restore a normal condition and pro- 
mote fertility. 

Define abortion, miscarriage, and premature labor. 

Abortion is the discharge of the ovum during the first tri- 



OBSTETRICS AND GYNECOLOGY. 457 

mester of pregnancy. Miscarriage is the discharge of the 
embryo during the second trimester. Premature labor is the 
delivery of the fetus after the period of viability and before 
full term. 

What is the management of abortion, both preventive 
and curative? Give its causes, diagnosis, and indications 
for treatment. 

The causes of abortion are numerous. They include cer- 
tain morbid states of the ovum and fetus, as apoplexy of the 
ovum, disease of the umbilical vesicle, disease of the fetal 
membranes, malposition of the placenta, disease of the fetus, 
as syphilis and hydrocephalus, death of the fetus, certain 
paternal causes, as a diseased spermatozoid, certain maternal 
diseases, as the exanthemata, valvular heart-disease, renal 
inadequacy, convulsive disorders, as chorea and epilepsy, 
malformations of the uterus, profound mental shock, and 
traumatism. 

The symptoms of abortion are sacral discomfort, steadily 
increasing hemorrhage, uterine contractions, and finally ex- 
pulsion of a part or the whole of the product of conception. 
The diagnosis may be made by a study of the symptoms, by 
the physical signs, and by an examination of the discharged 
products. The preventive treatment consists in absolute 
quiet and rest in bed, lowering of the head, the administra- 
tion of nerve-sedatives, as sodium bromid, and the introduc- 
tion of an opium suppository. The curative treatment con- 
sists in vaginal and cervical tamponade to control bleeding, 
followed by emptying of the uterine contents. 

What are the premonitory symptoms of abortion? 

At the best these are vague and unreliable. They consist 
in a sense of discomfort or fulness in the pelvis, sacral pains, 
a feeling of malaise, a tendency to vesical tenesmus, chilly 
sensations, and beginning discharge of serum or blood from 
the uterus. 



458 OBSTETRICS AND GYNECOLOGY. 

What are the symptoms of threatened abortion? 

Pain, increasing hemorrhage, and opening of the uterine 
mouth. 

Describe the symptoms and give the management of an 
incomplete abortion. 

The body of the uterus will he large, soft and boggy; the 
cervical canal will be patulous; the finger introduced into 
the cavity of the uterus will detect clots, fragments of mem- 
brane and pieces of soft, pulpy, placental tissue ; the discharge 
will be dark, hemorrhagic and grumous, and there may or 
may not be a fetid odor. The treatment consists in the asep- 
tic removal of the uterine contents by means of the finger or 
placental forceps, followed by an intra-uterine douche of mer- 
curic chlorid, 1-4000, and the administration of small doses 
of ergot if the hemorrhage persist. 

What are the symptoms of an inevitable abortion? 

Steadily increasing hemorrhage and pain despite the pre- 
ventive treatment, and the presence of Tarnier's sign, namely, 
obliteration of the angle of flexion between the upper and 
lower uterine segments by the descent of the detached ovum. 

What means should be employed to prevent threatened 
abortion during the first three months of pregnancy? 

The avoidance of over-exertion, the correction of uterine 
displacement, rest in bed at the menstrual epochs, the admin- 
istration of sodium bromide, viburnum prunif olium and other 
sedatives, and occasionally the use of an opium suppository. 

How should inevitable abortion be managed? 

A vaginal and intracervical tampon should be introduced 
and left in situ for 8 hours. On its removal the ovum will 
probably be found attached to it. If not, a second tampon 
may be introduced and retained for from 6 to 8 hours. If this 
fails to bring the ovum away the patient should be anesthe- 
tized and the product removed by the finger or the placental 
forceps. 



OBSTETRICS AND GYNECOLOGY. 459 

When and how should abortion be induced? 

The induction of abortion is indicated when maternal life 
is menaced by some grave pathologic state of the fetus or of 
the mother, as cystic disease of the chorion, acute hydramnios, 
large uterine or pelvic tumors, extreme pelvic contraction, 
pernicious vomiting, pernicious anemia, chronic nephritis 
and the like. The best method of inducing abortion consists 
in rapid dilatation of the cervix after thorough asepsis of the 
vagina, with the immediate removal of the ovum by the finger 
and placental forceps. 

Is the production of premature labor ever justifiable? 
If so, when and how would you accomplish that object? 

The indications for the induction of premature labor in- 
clude all conditions menacing fetal or maternal life, as well 
as those pathologic states of either mother or child that will, 
if the pregnancy be allowed to continue to term, be productive 
of grave degrees of dystocia. These are, oversize or prema- 
ture ossification of the upper portion of the fetal skull, acute 
hydramnios occurring late in pregnancy, habitual death of 
the fetus during the last days or weeks of pregnancy, pelvic 
deformity, placenta prsevia, pernicious anemia, pernicious 
vomiting, increasing albuminuria, eclampsia, grave valvular 
disease, advanced pulmonary tuberculosis, tumors in the pel- 
vic canal. The best method of inducing labor is the intro- 
duction of an aseptic rubber catheter into the uterus. Other 
methods include the use of Barnes' or Champetier de Ribes r 
bags, and rapid digital divulsion of the cervix with the per- 
formance of podalic version. 

Define and classify ectopic pregnancy. Give its causes, 
symptoms and treatment. 

Ectopic or extra-uterine pregnancy is a generic term mean- 
ing pregnancy at any point outside of the uterus. This 
includes tubal pregnancy, interstitial pregnancy , tubo-ovarian 
pregnancy, ovarian pregnancy, and primary and secondary 
abdominal pregnancy . The causes of this condition are un- 



460 OBSTETRICS AND GYNECOLOGY. 

known. The condition is generally encountered in women 
who are between 20 and 30 years of age, and who present a 
history of a protracted period of sterility following one or 
more pregnancies. It was formerly believed to be due to a 
salpingitis, but Sutton now states that it is more liable to 
occur in a healthy tube. Tubal diverticula may produce it. 
The symptoms are the presence of all the signs of early ges- 
tation, irregularity in the menstrual history, vaginal pulsa- 
tion, lancinating, cramp-like pains in the affected side, slight 
elevation of temperature, and lateral displacement of the 
uterus by a very sensitive mass. The treatment consists in 
immediate abdominal section and removal of the gestation-sac. 

What are some of the possible terminations of a tubal 
pregnancy? 

Tubal pregnancy may terminate in rupture, which is usual. 
In a certain percentage of cases the embryo may die within 
the first few weeks of gestation ; this is known as the sponta- 
neous cure of extra-uterine pregnancy. Rarely the condition 
may go to term. 

What are the symptoms of rupture in ectopic preg= 
nancy? What should be done when such rupture occurs? 

The symptoms of rupture are sudden and characteristic. 
They consist in exceedingly severe cramp-like pains in the 
iliac region of the affected side, associated with collapse and 
the symptoms of concealed hemorrhage, namely, extremei 
pallor of the surface, feeble runnng pulse, air-hunger, moist, 
clammy skin, coldness of the extremities, vomiting, and fre- 
quently coma. There is an increased discharge from the 
vagina ; large masses of decidual tissue are usually discharged 
at this time. Immediate laparotomy should be performed. 

What preliminary preparations would you suggest for 
a case of labor? 

The thorough disinfection of the physician, nurse and 
patient according to the accepted methods, the opening of the 



OBSTETRICS AND GYNECOLOGY. 461 

patient's "bowels by means of a rectal enema, the proper 
preparation of the patient's clothing and bed. The nurse 
should have on hand the various drugs and instruments, as 
well as hot water, for whatever obstetric operation may be 
required. 

What is labor? 

Labor is that natural process by which a pregnant woman 
expels the product of conception at the full expiration of the 
period of pregnancy, 280 days after conception. 

Into what stages is labor divided, and where do these 
stages begin and end? 

There are three stages of labor. The first or stage of dila- 
tation begins with the first labor pain and continues until the 
os is fully dilated. The second stage or stage of expulsion 
extends from full dilatation until the delivery of the child 
is accomplished. The third stage or stage of the placenta 
extends from the delivery of the child until the expulsion of 
the after-birth. 

What are the prodromata of labor? 

The onset of labor is indicated from 2 to 4 weeks before by 
the phenomenon known as Uglitening. This is produced by 
the entrance of the child's head into the superior strait, and 
occurs 2 weeks before term in multiparas and 4 weeks before 
term in primiparae. The symptoms of beginning labor are 
pain, beginning dilatation of the os, and a bloody discharge 
known as the shoiv. 

What is the diagnosis of false from true labor pains? 

False labor pains are annoying, colicky sensations occur- 
ring during the last 2 or 3 weeks of pregnancy, which usually 
depend upon constipation or pressure upon nerve-trunks. 
They are irregular in their location, and are not accompanied 
by dilatation of the os. True labor pains are involuntary 
and painful contractions of the uterine muscles occurring 
intermittently and with increasing severity at decreasing in- 



462 OBSTETRICS AND GYNECOLOGY. 

tervals. They are usually felt in the small of the back, and 
from this point pass around the abdomen. They may reverse 
this direction, and, commencing at the umbilicus, pass back- 
ward to the sacrum. They are cumulative in nature, of 
unequal intensity, and last from one-half to one minute. 
They result in dilatation of the os. 

Give the character, situation and cause of the pains 
during the first and second stages of labor. 

During the first stage of labor the pains are as described in 
the foregoing answer. They result from squeezing of the 
nerve-fibrils by the contracting of the uterine muscles. They 
are colicky in nature, and aside from opening the os do not 
favor the expulsion of the child. In the second stage of labor 
the character of the pains changes. They become bearing- 
down or expulsive in nature. The pain now is due to pres- 
sure upon the soft tissues of the lower parturient canal, as 
well as to the pressure upon the nerve-fibrils above. 

What means are employed to stimulate ineffective 
uterine contractions? 

The administration of quinine in large doses, the application 
of a firm abdominal binder, keeping the woman upon her feet, 
and the taking of a small amount of food may all result in an 
increase of the uterine pain. Ergot or its substitutes should 
not be administered. 

What is meant by the mechanism of labor? 

By the mechanism of labor is meant the manner in which 
the fetus and secundines pass through the parturient canal 
and are expelled. 

Define and differentiate position, presentation, and ro= 
tation. 

By position is meant: 1. The varying relationship borne 
by the most prominent point of the presenting part of the 
fetus to the cardinal points of the pelvis. 2. The relationship 
existing between the long axis of the fetus and that of the 
maternal body. 



OBSTETRICS AND GYNECOLOGY. 463 

By presentation is meant that portion of the fetal body 
which is detected by the examining finger introduced to the 
center of the plane of the superior strait. 

By rotation is meant the turning of the presenting part 
from right to left or left to right after it has struck the pelvic 
floor, so that it comes to present under the pubic symphysis. 
External rotation is a return of the presenting part to the 
side from which it comes after it has been delivered through 
the vulvar orifice. 

Give the normal vertex presentations in the order of 
their frequency. 

1. Left occipito-anterior, L. 0. A. ; 2. Right occipito-pos- 
terior, R. 0. P. ; 3. Right occipito-anterior, R. 0. A. ; 4. Left 
occipito-posterior, L. 0. P. 

What is the most common presentation and which the 
most frequent position of the presenting part in normal 
labor? Give the average duration of a natural labor. 

The most common fetal presentation is the occipital or 
vertex; the most frequent position is the left occipito-anterior, 
L. 0. A. The average duration of labor in a primipara is 
from 12 to 15 hours; in a multipara from 8 to 10 hours. 

Give the formation of the caput succedaneum. Where 
does the caput succedaneum appear in the third position? 

The caput succedaneum or "accessory head" is the tumor 
situated upon the presenting part of the fetus. It is formed 
by a serosanguineous infiltration of the connective tissue of 
the part. It is due to an edema of the part that is not com- 
pressed by the maternal structures. In the third position 
of the vertex, R. 0. P., the caput appears on the left parietal 
eminence. 

Describe the mechanism of labor in L. O. A. presen= 
tation. 

Adaptation of the fetal presentation to the pelvic strait. 
It consists of three steps, namely, preliminary flexion and 



464 OBSTETRICS AND GYNECOLOGY. 

moulding occurring with the phenomenon of lightening ; fur- 
ther flexion and moulding occurring with the first labor pains ; 
and Naegele 's obliquity, or lateral inclination of the fetal head 
toward the maternal sacrum, the right parietal bone present- 
ing. The birth-canal is next prepared by being dilated by 
means of the bag of waters. The presentation next descends 
to the pelvic floor, the occiput resting on the floor. Internal 
anterior rotation of the occiput from left to right now occurs, 
the occiput resting beneath the symphysis pubis. Birth of 
the head by a process of extension follows, the perineum 
retracting over the face, which appears first at the forehead 
and eyes and finally at the chin. Restitution or untwisting 
of the neck is then followed by external rotation of the head, 
which becomes transverse, with the occiput to the left side. 
The birth of the shoulders follows, the anterior or right shoul- 
der rotating from right to left; the rest of the trunk is then 
rapidly expelled. 

Describe the mechanism of labor in the L. O. P. position. 

The steps of the mechanism are the same as in the foregoing 
except that the head has further to rotate in order to reach 
the symphysis, and this excessive rotation requires a rotation 
of the shoulders at the superior strait from the right into the 
left oblique diameter, the anterior shoulder rotating from 
left to right. After restitution this shoulder rotates back 
again to the middle line from right to left. The rest of the 
mechanism is as in the L. 0. A. presentations. 

Name and describe the various forms of head=presenta= 
tion, with the management appropriate to each. 

The vertex presentation is most common; its management 
is that of an ordinary case of labor. Broiv and face presen- 
tations are always abnormal, and will be described further 
on. Presentation of the bregma is the so-called ' ' military posi- 
tion ' ' of the fetus, the head being midway between flexion and 
extension, and set squarely on the shoulders. The large 
occipitofrontal diameter of the fetal skull (11% cm.) pre- 



OBSTETRICS AND GYNECOLOGY. 465 

sents. This presentation must be converted into an occipital 
presentation in order to permit labor to proceed. Ear pre- 
sentation is a laterally deviated vertex presentation, and can 
generally be corrected manually or by altering the position 
of the patient. 

Give the face and breech presentations of the fetus. 

The face presentations are : 1. Left mento-anterior, L. M. 
A. ; 2. Eight mento-anterior, R. M. A. ; 3. Right mento-pos- 
terior, R. M. P. ; 4. Left mento-posterior, L. M. P. The 
breech presentations are : 1. Left sacro-anterior, L. S. A. ; 2. 
Right sacro-anterior, R. S. A. ; 3. Right saero-posterior, 
R. S. P. ; 4. Left sacro-posterior, L. S. P. 

Give the causes of cephalic presentations, and state why 
vertex presentations are favorable. 

The causes of cephalic presentation are : 1. The peculiar 
shape of the uterus and of the fetal ellipse, the smaller ex- 
tremity of the fetal ellipse accommodating itself to the smaller 
portion of the uterine cavity; 2. The fetal center of gravity 
lies near the head, which becomes the dependent portion. 

How would you know a head=presentation? How a 
breech presentation? How a transverse presentation? 

In cephalic presentations palpation externally reveals the 
hard fetal skull at the superior strait; vaginal examination 
will reveal the dome-like projection of the brow or the vertex, 
or the features of the face. In breech presentations, if the 
membranes have broken, there will be a discharge of meco- 
nium; palpation will also show the soft pelvic structures, 
while externally the head can be felt at the upper portion of 
the abdominal wall. In transverse presentation the long axis 
of the fetus lies at right angles to the long axis of the maternal 
body; vaginal examination is liable to show an arm or elbow 
presenting. 

Describe the mechanism of expulsion in natural labor. 

Expulsion is accomplished by the direct action of the 
30 



466 OBSTETRICS AND GYNECOLOGY. 

uterine muscles upon the fetal body. The fetus is expelled 
because there is a decided diminution in the intra-uterine 
space, and the intra-uterine contents are propelled in the 
direction of least resistance, down the lower canal. 

What is the " bag of waters," its functions and man= 
agement during labor? 

The bag of waters is the tough elastic membrane containing 
the liquor amnii, which can be felt protruding through the 
os during the process of dilatation. Its function in labor is 
to distend the cervical fibers, which it does by hydraulic pres- 
sure. It should never be ruptured in primiparous women, 
and in multiparas only after full dilatation of the os has been 
accomplished. 

State the causes of dilatation of the os and cervix uteri 
as related to labor. 

There are two causes of cervical dilatation in labor, namely, 
the wedge-like action of the bag of waters acting on the 
edematous cervical tissues, and the upward traction exerted 
by the longitudinal layer of muscular fibers in the uterine 
walls. 

Give a brief description of the three stages of labor. 

During the first stage of labor the pains occur at intervals 
of 30 to 5 minutes ; they accomplish during this time the 
dilatation of the os. This stage may take from 2 to 20 hours, 
and the patient for most of this time may remain out of bed. 
In the second or expulsive stage, the patient lying in bed, the 
pains occur every % to 5 minutes, and are assisted by volun- 
tary bearing-down on the part of the patient. This drives 
the presentation down upon the perineum, which bulges, and 
by its resistance directs the presentation to the vulvar orifice, 
through which it finally emerges. This stage consumes from 
30 minutes to 2 hours. The third stage, which seldom lasts 
over half an hour, consists in the expulsion of the placenta 
and membranes. 

What may cause premature rupture of the membrane? 



OBSTETRICS AND GYNECOLOGY. 467 

How may this rupture influence the progress and conduct 
of labor? 

Undue tenuity of the membranes may cause rupture to 
occur with the first labor pains. They may also be ruptured 
by the careless introduction of the finger during a pain. 
When the water escapes early the labor is said to be "dry." 
This results in slow progress of the presenting part, and in 
tedious dilatation of the os. The cervix is liable to extensive 
lacerations in such cases. 

Give the management of the second stage of labor. 

The patient lies upon the side toward which the fetal back 
is directed. In multiparas, if the membranes fail to rupture 
after full dilatation of the os, the obstetrician may break 
them with the finger-nail during the interval between two 
pains ; the water should be allowed to escape slowly. As the 
head descends to the floor the perineum must be guarded 
from laceration; on delivery of the head it should be sup- 
ported until the shoulders emerge, and as the child descends 
the hand should be placed upon the fundus uteri to maintain 
good contraction of the uterine muscle. 

Define the third stage of labor, and state how it should 
be managed. 

This is the period of placental expulsion. Immediately 
after the birth of the child the uterus contracts and the pla- 
centa sinks to the lower uterine segment. Here it lies for 15 
to 30 minutes, when a strong. contraction occurs and the pla- 
centa is expelled. The accoucheur may, after ligation of the 
cord, hasten this delivery of the secun dines by the applica- 
tion of Crede's method. If hemorrhage occurs or the uterus 
fails to contract, fluid extract of ergot may be administered, 
and a firm pad and binder should be applied. 

Describe the delivery of the placenta after the method 
of Crede. 

This consists in applying gentle rotatory friction to the 



468 OBSTETRICS AND GYNECOLOGY. 

fundus uteri until it is felt to harden under the influence of 
a uterine contraction; the fundus is then grasped by the hand 
and compressed, while at the same time pressure is made 
downward and 'backward in the line of the axis of the par- 
turient canal. The placenta is rapidly expelled by this 
process. 

Describe the preparation of the bed, the woman, the 
physician and the nurse for a case of labor. 

The bed-linen should be clean, and on the side on which 
the woman lies the special temporary coverings should be- 
laid. These include a large pad, a clean sheet, and a rubber 
blanket. These are removed after delivery is accomplished. 
The woman, as soon as labor begins, is given a full bath, and 
the external genitalia are cleansed with green soap and alco- 
hol. A clean garment is worn, and this is rolled up above 
the hips to prevent soiling. She is covered with a clean sheet. 
The physician and nurse disinfect themselves according to 
the accepted methods of aseptic surgery. 

Give the causes of separation of the placenta. State 
how the placenta normally presents at the os uteri. De= 
scribe the treatment. , 

It is probable that the main cause of placental separation 
is a diminution in the area of placental attachment due to the 
excessive uterine contraction. Another view is that there 
occurs a partial central detachment of the placenta, with sub- 
sequent retroplacental hemorrhage. The separation does not 
occur until the beginning of the third stage of labor. The 
placenta once separated is expelled to the os uteri by passing 
through and inverting the membranes which drag after it; 
the body of the placenta bulges forward in a spherical form. 
Duncan's theory is that the placenta slides down the lower 
uterine segment edgewise. The treatment of placental sepa- 
ration is expulsion by Crede 's manipulation. 

What is the management of retained placenta? 

Retained placenta is quite distinct from adherent placenta. 



OBSTETRICS AND GYNECOLOGY. 469 

The former means a resting of the detached placenta in the 
temporarily paralyzed lower uterine segment. It is a harm- 
less condition, and is treated by Crede's expression. Adhe- 
rent placenta is one that is partially detached, but remains 
adherent at points to the original site of placental attach- 
ment. It causes post-partum hemorrhage, and requires imme- 
diate manual extraction. 

How should the first examination be made at the bed= 
side of a woman in labor? 

The object of the examination is to determine the position 
and presentation of the child, its condition, the progress of 
the labor, the size of the maternal pelvis and the condition 
of the soft structures of the parturient canal. The abdomen 
is first palpated and ausculted, the patient lying on her back. 
A vaginal examination is then made with the patient in the 
left lateral recumbent posture. The finger is retained against 
the membranes until the patient has had a pain in order that 
the efficiency of the pains may be determined. 

What is the perineum? How is it endangered in labor, 
and how should it be protected? 

The perineum is the pelvic floor, composed mainly of mus- 
cles and fibrous tissues. The main muscle is the levator ani, 
a large butterfly-shaped muscle, which affords the chief sup- 
port to the pelvic viscera. As the head descends it impinges 
on the perineum and stretches it; not infrequently serious 
lacerations result in consequence of too precipitate delivery, 
disproportion between the head and vulvar orifice, or imper- 
fections in the mechanism of labor. There are various means 
of protecting the floor in labor. The head may be retarded 
by Hold's method, which consists in pressing the thumb 
against the occiput above and the index and middle fingers 
posteriorly against that portion of the head nearest the four- 
chet. The forceps may be applied and the movement of the 
nead controlled. Ritfien's method of elevating the head and 
Olshausen's method of rectal expression are both valuable. 



470 OBSTETRICS AND GYNECOLOGY. 

What is episiotomy, and when is such interference in- 
dicated? 

Episiotomy is the making of a lateral incision of the vulva 
for the purpose of relieving vulvar and perineal tension. 
The incisions are made during the height of a pain upon the- 
mucosa just within the vulvar cleft, and are from % to % 
inch long and 14 inch deep. The operation should not be 
performed, simple perineal laceration 'being preferable. 

How should laceration of the perineum occurring dur- 
ing labor be treated? 

By immediate suturation if the tear be over y 2 inch long. 
Simple tears of the f ourchet do not require suturing. Inter- 
nal tears of the sulci and tears involving the sphincter require 
immediate repair. If the tear is a simple median tear, and 
the tissues are severely bruised, a primary perineorrhaphy 
may not prove successful. 

Give the causes and treatment of laceration of the cer= 
vix uteri. 

Abortion or miscarriage when the cervix is still rigid ; pre- 
cipitate delivery, especially if the woman be on her feet; 
oversize of the fetal parts; instrumental delivery, the head 
not yet having escaped from the uterus. If there is no hem- 
orrhage from the tear nothing should be done. If the circular- 
artery has been cut a suture must be introduced at once. 

Give the rules for administering anesthetics in labor, 
stating when they are indicated. 

No anesthetic is required in a normal labor until the head 
is down on the perineum ; it is then well, if the pains be severe 
and the patient suffering unduly, to administer a few drops 
of ether or chloroform, not sufficient to arrest the uterine 
contraction, but enough to dull the pain. In all operative 
procedures full anesthesia will be required. In puerperal 
eclampsia during the convulsions chloroform should be ad- 
ministered; also in the spasms of major chorea. 



OBSTETRICS AND GYNECOLOGY. 471 

State the effects of anesthetics on the os uteri, cervix 
uteri, abdominal muscles, perineum and child. 

If the anesthesia be complete the cervix, os and perineum 
become relaxed ; all voluntary motion ceases, and the rigidity 
of the part is overcome. A certain amount of fetal asphyxia 
results in profound maternal anesthesia. The labor is neces- 
sarily protracted, since the uterine contractions are largely 
or completely abolished. 

What are the antiseptic measures to be employed in the 
care of a case of labor? Define the terms asepsis and 
antisepsis, and give their proper application in the Iying= 
in chamber. 

Asepsis means absence of septic matter, or freedom from 
infection. Antisepsis means exclusion of the germs that 
cause putrefaction or infection. As applied to labor it means 
the thorough cleanliness of the patient, bed, room, water, 
instruments, dressings, clothing, physician and nurse. It in- 
cludes the use of antiseptic agents, such as carbolic acid, 
mercuric chloride, creolin, lysol, and the like. It includes for 
some the use of rubber gloves and the exclusion, as far as 
possible, of the vaginal examination. 

What would contraindicate the use of anesthetics in 
labor? 

Grave renal disease and any severe pulmonary affection. 

What preliminary preparations are necessary for the 
safe conduct of labor? 

The nurse should have on hand aseptic dressings, anti- 
septic agents, sterile water, hemostatic remedies, as gauze, 
ergotin and hot water, bichloride tablets, creolin or lysol, 
chloroform to meet an eclamptic seizure, obstetric forceps, 
and whatever else may be needed to meet any emergency. 

What are the dangers to the mother during the second 
stage of labor, and how can they be minimized? 

The dangers are uterine inertia, with prolonged pressure 



472 OBSTETRICS AND GYNECOLOGY. 

of the fetal head upon the maternal tissues, which might 
result in a slough; the onset of eclampsia; rupture of the 
uterus from obstruction; laceration of the cervix and peri- 
neum from disproportion between the head and vulvar orifice, 
or from precipitate labor; hemorrhage from premature sepa- 
ration of the placenta; apoplexy or syncope; rupture of 
varicose veins. 

What are the uses and dangers of ergot in obstetric 
practice? 

The routine administration of ergot is to be condemned. 
It should be employed in uterine exhaustion and inertia 
during the late second and third stages of labor and after 
delivery has been completed. If given too early it may cause 
an irregular hour-glass contraction of the uterus, with reten- 
tion of placenta, clots, membranes, or debris. It has a re- 
tarding influence upon the development of the milk. It may, 
if given early, cause fetal asphyxia from tetanic uterine con- 
traction. It also increases the danger of cervical and peri- 
neal lacerations. 

State under what circumstances the vaginal douche may 
be employed before, during, and after labor. Give the 
technic. 

Unless the patient be already infected, as from gonorrhea, 
a vaginal douche should not be given before labor, in order 
to avoid introduction of germs with the nozzle of the syringe 
and the washing away of the normal vaginal secretion. Dur- 
ing labor a douche is given only when there is a profuse 
gonorrheal discharge or when some obstetric operation is 
about to be performed. After normal labor no douche is re- 
quired as a rule. If there has been much manipulation of 
the parts, or version or other operation has been performed, 
one douche should be given, mercuric chloride 1-2000 being 
employed. If the lochia become offensive at any time, vag- 
inal douching should be begun at once. 



OBSTETRICS AND GYNECOLOGY. 473 

Describe the duties of the accoucheur during normal 
labor. 

He is to act simply as an overseer. Examination should 
not be made too freely ; only often enough to note a satisfac- 
tory progress of the labor. During the second stage he should 
regulate the descent of the head, institute measures to pre- 
serve the perineum, support the head after delivery until the 
shoulders are born, attend to the mouth and eyes of the child, 
ligate the cord, and superintend the discharge of the secun- 
dines. He should see that uterine relaxation does not occur, 
and after the patient has been cleaned he should apply the 
pad and binder. He should see that the proper toilet for the 
baby is made. 

What care does the mother require after labor? 

She should be covered to prevent chilling and shock. She 
should be cleaned as soon as possible, and the proper occlu- 
sive dressing of the vulva applied and secured to the abdom- 
inal binder. The bed should be made, and clean clothing for 
it and the patient be provided. If there is a tendency to 
relaxation of the uterus, ergot should be administered. The 
head should be kept low and visitors excluded. The visits 
should be made at suitable intervals, and careful watch kept 
of the pulse, temperature, discharge and breasts. The prog- 
ress of involution should be noted. The bowels should be 
opened by the third day and the proper diet instituted. 

What is involution? Define subinvolution. How long 
a time is usually required for involution, how may it be 
promoted, and what causes may operate to delay or pre= 
vent it? 

By involution, as applied to the uterus, is meant the retro- 
gressive change undergone by that organ after parturition, 
by which it returns to its normal weight and condition. It 
is brought about mainly by a rapid fatty degeneration of the 
hypertrophied muscular tissue. It is completed in six weeks, 



474 OBSTETRICS AND GYNECOLOGY. 

and is favored by rest in bed, the repair of cervical and peri- 
neal lacerations, the prevention of uterine displacements, and 
the nursing of the child. It is delayed by early rising, bottle- 
feeding of the baby, neglect of the cervix, uterus and peri- 
neum, and an early resumption of household duties. Subin- 
volution is a failure of the uterus to return to its normal size. 

What are after=pains? State their cause and give the 
treatment. 

After-pains are irregular and painful contractions of the 
uterus produced by efforts on the part of that organ to expel 
clots or shreds of membrane; they indicate a partial relaxa- 
tion of the uterine tissue, and are more common in multiparas. 
They are relieved by pressure, and 'are followed by the dis- 
charge of clots. The treatment consists in the administration 
of opiates and fluid extract of ergot, embrocations of chloro- 
form and belladonna liniments or a hypodermic injection of 
morphine. 

What general directions should be observed in passing 
the catheter on a patient during the puerperal state? 

Absolute cleanliness of the meatus and vestibule, as well as 
of the catheter, to prevent cystitis. The parts should be 
bathed in mercuric chloride 1-5000, and the patient should 
not be catheterized oftener than once in eight hours. 

What changes occur in the fetal circulation at birth? 

With the stopping of the feto-placental circulation there 
occurs a closure of the foramen ovale, the Eustachian valve 
atrophies, and the ductus venosus and ductus arteriosus close 
and atrophy ; the pulmonary circulation increases at once and 
becomes as in the adult individual. 

What indications of premature birth can be determined 
in the infant? 

Undersize of the infant; the nails do not project over the 
finger-ends; there may be some lanugo present, and there is 
an excess of vernix caseosa; the face is senile and wrinkled r 



OBSTETRICS AND GYNECOLOGY. 475 

and the development of the limbs imperfect; there is a ten- 
dency to subnormal temperature. 

How soon after the birth of the child should the um= 
bilical cord be ligated, and describe your method of pro= 
cedure? How should the umbilicus be managed? 

The cord should be ligated only after the pulsations have 
entirely ceased. A small-sized tape should be used, and the 
cord tied about two inches from the umbilicus, a surgeon's 
knot being used. It may be necessary in very thick cords to 
"strip" the cord so as to remove the excess of Wharton's 
jelly. The stump and umbilicus should be thickly dusted 
with a powder of salicylic acid 1 part and starch 4 parts, and 
then covered with salicylated cotton, through which the cord 
is passed. The whole is then supported by the binder. 

Describe the care of the infant during the first 24 hours 
after birth. 

After the establishment of respiration and the severing of 
the cord the baby should be given a bath. The vernix caseosa 
must be removed by rubbing with sweet oil. Castile soap 
and warm water are used in cleansing, and care must be 
taken not to irritate the delicate skin by rubbing. Diapers 
must be changed hourly, and plenty of talcum powder dusted 
on the body to prevent chafing. The breast should be given 
the baby every four hours. In this way it learns to nurse, 
consumes the colostrum, whereby the meconium will be ex- 
pelled, and by reflex action causes firmer uterine contraction. 

Describe the immediate care of the new=born child when 
for any reason the mother cannot nurse it. Give the rules 
for artificial feeding. 

The new-born baby does not need food for the first 24-36 
hours. It may be given a spoonful of water now and then, 
and if it seems hungry it may be given two or three spoon- 
fuls of a mixture of condensed milk and water 1 part to 12. 
If it becomes necessary to feed the baby from the bottle the 



476 OBSTETRICS AND GYNECOLOGY. 

latter must be kept absolutely clean, and a milk-preparation 
of suitable strength should be given. Germs may be de- 
stroyed by Pasteurization. The preparation usually employed 
consists of condensed milk 1 part, "foiled water 12 parts, 
cream 1 part, and limewater 1 part. The baby should be fed 
every 2 to 2% hours during the first month. The nursing 
should consume from 15 to 20 minutes. 

What instructions should be given a primipara in re= 
gard to lactation? 

She should be instructed a;s to the frequency of nursing 
and care of the nipple. Every 2 to 2y 2 hours by the clock 
is often enough for the feedings, and after the nursing the 
nipple should be bathed in warm water, thoroughly dried 
with a soft towel or lint, and anointed with sweet oil. The 
oil should be removed before the nipple is given to the infant 
at the next feeding. 

How soon after parturition should a woman men= 
struate? 

If she nurse her baby, menstruation does not normally 
return until the ninth month. An early appearance of the 
menstrual flow usually indicates subinvolution of the uterus 
or cervical laceration. 

What is the puerperal state? 

The puerperal state or puerperium is the period following 
the delivery of the placenta, in which the processes of involu- 
tion are being carried on. It is characterized by rapid dimin- 
ution in the size of the uterus and vagina, decrease in the 
pelvic circulation, and lessening in the quantity of blood 
circulating in the body. 

What are the most frequent complications of the puer= 
peral period? 

Infection of the birth-eanal, subinvolution, inflammation 
and abscess of the mammary gland, postpartum hemorrhage, 
and constipation. 



OBSTETRICS AND GYNECOLOGY. 477 

How should a case of labor be conducted to avoid puer= 
peral infection? What are the sources of septic infection 
in the puerperal state, and what would be the proper 
management if infection should occur? 

Thorough, asepsis of the woman, bed, surroundings, physi- 
cian and nurse, as already delineated, must be insisted upon. 
The hands of the physician and nurse, the water employed. 
and the instruments are the chief sources of danger. Should 
infection occur, the vagina and uterus should be well douched 
with mercuric chloride 1-2000-^000, and the uterus curetted 
with a dull curet to remove decaying fragments of placenta 
and membranes. This will generally be sufficient for local 
treatment. Internally, quinine, stimulants and strychnine 
must be administered. The graver forms of puerperal sepsis 
require special courses of treatment. 

Describe the proper method of delivering an adherent 
placenta at term. 

The hand, which should be aseptic, must be immediately 
introduced into the uterine cavity to the fundus, following 
the umbilical cord to the placental site. The placenta should 
be grasped and the adherent portions pinched off rapidly. 
The external hand grasps the uterine fundus and the internal 
hand is expelled by the uterine contractions. A hot douche, 
intrauterine, must then be given, and ergot administered by 
the mouth or hypodermatically. Firm uterine contractions 
must be secured before the patient is left. 

How would you treat asphyxia in the new=born child? 
What are its causes and symptoms? 

The causes of asphyxia neonatorum are syphilitic stenosis 
of the vessels of the cord and placenta, abnormality of the 
heart or great vessels, early separation of the placenta, undue 
pressure upon the cord, sudden maternal death, renal in- 
adequacy, and grave maternal lung disease. The condition 
appears in two forms, viz., asphyxia liviela and asphyxia 



478 OBSTETRICS AND GYNECOLOGY. 

pallida. In the former the baby is blue or livid, there are 
irregular gasping efforts, the heart-beats are strong, and the 
reflexes are preserved. In the pale variety respiration is 
altogether abolished, the surface is pale, the heart-sounds are 
weak and irregular, and the reflexes are absent. The treat- 
ment consists in early ligation of the cord, suspension of the 
child by the feet, cleansing of the throat and mouth by the 
finger, slapping the back and buttocks, the pouring of water 
or ether on the epigastrium, and in the pronounced cases the 
employment of some form of artificial respiration, notably the 
methods of Dew, Laborde, Schultze and Prochownick. Occa- 
sionally mouth-to-mouth insufflation, catheterization of the 
larynx, or tracheotomy may be required. 

Describe a method of resuscitation of the new=born. 

Deiv's method is excellent. The infant is grasped in the 
left hand in such a manner that the neck rests between the 
thumb and forefinger and the head hangs over in the position 
of full extension; the upper portion of the back rests in the 
palm of the hand, while the remaining fingers are inserted 
into the left axilla. The knees are grasped by the right hand, 
the right knee resting between the thumb and forefinger, the 
left knee between the index and middle fingers, and the thighs 
in the palm of the hand. The right hand depresses the body 
to favor inspiration, while to secure expiration the movement 
is reversed and the child doubled upon itself. 

What are the results of subinvolution of the uterus, 
and what is its treatment? 

Subinvolution of the uterus, if not corrected, results in a 
chronic endometritis, retrodisplacement, and subsequent pro- 
lapse of the uterus from increased specific gravity, and the 
development of a chronic invalidism. The treatment consists 
in the retention of the uterus in its normal position by means 
of a pessary, 'Curettage of the uterus, suturation of all cervical 
and perineal lacerations, and the administration of tonics, 
ergot and thyroid extract. 



OBSTETRICS AND GYNECOLOGY. 479 

How would you recognize retention of urine during 
labor and how after labor? Minutely describe the treat= 
ment that should be employed in each case. 

Retention of urine during labor is exceedingly uncommon. 
It might result from an uncorrected retrodisplacement of the 
uterus that has gone on to succulation. In such a case, if 
catheterization of the bladder by the prostatic catheter fails, 
suprapubic puncture of the bladder would be required. Re- 
tention of urine after labor is not uncommon. It is char- 
acterized by inability on the part of the patient to urinate, 
severe pain in the bladder, and the development of a cystic 
tumor over the symphysis, which presents dullness on percus- 
sion. The treatment consists in aseptic catheterization, with 
withdrawal of one-half to three-fourths of the vesical con- 
tents, in order to avoid syncope. 

Describe the technic of intrauterine irrigation and state 
when its employment is justifiable. 

Intra-uterine irrigation is required only after some intra- 
uterine manipulation, as the performance of version, manual 
extraction of the placenta, or high forceps application, or in 
case puerperal sepsis has developed. The technic consists in 
antiseptic douching of the vagina and vulva, followed by the 
introduction to the uterine fundus of the two-way catheter. 
Mercuric chloride 1-4000, creolin, lysol or sterile water may 
be employed. The douching may be resorted to once, twice 
or three times daily, according to the gravity of the patient's 
condition. 

Mention the pathogenic bacteria that invade the vagina, 
and state how the vagina is normally protected from them. 

A number of pathogenic germs have been discovered in the 
vagina. The most common are the streptococcus pyogenes, 
staphylococcus pyogenes aureus, staphylococcus pyogenes 
albus, bacterium coli commune, bacillus pyocyaneus, bacillus 
pyogenes foetidus, and others. There normally exist in the 



480 OBSTETRICS AND GYNECOLOGY. 

vagina a large number of long-rod bacilli known as Doder- 
lein's bacilli. These secrete an acid which destroys patho- 
genic germs. 

Define puerperal sepsis, and state how to prevent it and 
how to overcome it. What is auto=infection? 

Puerperal sepsis is the infection of the puerperal woman 
by pathogenic germs. It may be prevented by careful atten- 
tion to the laws of asepsis and antisepsis. If septic infection 
developed it should be combated in the manner already de- 
scribed. v Auto-infection of the puerperal woman is a rare 
form of sepsis, in which the germs are already in her system 
before the onset of labor, and become active immediately 
after parturition. 

State the causes, pathology, symptoms, treatment and 
sequelae of puerperal phlebitis. 

Puerperal phleoitis is a rare form of puerperal sepsis 
originating in the sinuses of the uterus. The germs invade 
the clots in the mouths of the sinuses ; these quickly liquefy, 
and give rise to hemorrhages and to emboli, which are carried 
to remote portions of the body. This may result in instant 
death or in pyemia, with septic pneumonia, paralysis, and 
other serious consequences. The treatment consists in the 
general treatment of puerperal sepsis, with avoidance of all 
local interference other than the introduction of a gauze tam- 
pon to control the hemorrhage. 

How would you diagnose puerperal metritis, and what 
methods would you employ in its treatment? 

Puerperal metritis is a late septic inflammation of the- 
uterine muscle. It is characterized by an offensive lochial 
discharge, which contains fragments of necrotic tissue and 
detached portions of muscular fibers that have sloughed from 
the uterine wall. The uterus is large, soft, boggy and sen- 
sitive. There is danger of perforation of the uterine walls 
and the development of general peritonitis. Uterine phlebitis 



OBSTETRICS AND GYNECOLOGY. 481 

may also develop, with a resulting general pyemia. The 
treatment consists in hysterectomy performed with thorough 
asepsis. 

Define hysterectomy, and state when it is applicable in 
obstetric complications. 

Hysterectomy is excision of the uterus. It is indicated in 
puerperal metritis, extensive involvement of the broad liga- 
ments, and when tubal and ovarian infection is associated 
with profuse hemorrhage from the uterus. 

What is phlegmasia alba dolens? Give the varieties, 
symptoms and treatment. 

Phlegmasia alba dolens or "milky leg" is a peculiar late 
manifestation of puerperal sepsis, in which there occurs a 
thrombosis of the iliac or femoral veins on one side, usually 
the left, with an immense edema of the affected limb, which 
presents a characteristic white or milky appearance. In the 
phlebitic or thrombotic form the edema first appears below 
at the ankle, the disease occurring as a sequel of uterine 
phlebitis, coagula being carried from the placental site into 
the hypogastric veins. In the cellulitic form the disease 
occurs as a result of a direct extension of an inflammatory 
process from the uterus through the broad ligament and pelvic 
cellular tissue, the exudate occluding the iliac veins. The 
symptoms are pains in the affected limbs along the course of 
the femoral vein, rapid pulse, elevation of temperature, 
cramp-like pains in the calf, edema, and extreme pallor of the 
limb, or, in a certain proportion of the cases, bluing of the 
leg; abscess or gangrene may follow. The treatment consists 
in the administration of stimulants and tonics, disinfection 
of the birth-canal, gentle laxatives, and immobilization of the 
limb, which should be elevated and kept warm. Anodyne 
poultices, and later ichthyol and belladonna ointments, may 
be applied. Abscesses should be opened, and if gangrene 
occurs amputation is necessary. 
31 



482 OBSTETRICS AND GYNECOLOGY. 

What is postpartum hemorrhage? State the causes and 
varieties, and give the treatment, including prophylaxis. 

Postpartum hemorrhage or "flooding" is hemorrhage oc- 
curring at any time during the 24 hours after parturition. 
It may be primary, at the time of delivery, or secondary, 
when it occurs after contraction of the uterus has been 
secured. Its causes are retention of placental debris, adher- 
ent placenta, uterine inertia, or severe laceration of the lower 
birth-canal. The symptoms are free escape of blood, pallor, 
running pulse, restlessness, and coma. The prophylactic 
treatment includes the use of strychnine and tonics during 
the last trimester of pregnancy, and at the time of labor the 
avoidance of extreme exhaustion, and if the uterus be atonic 
the administration of a dram of ergot as soon as the head is 
born. The active treatment consists in the immediate removal 
of all clots and debris, the application of Crede's manipula- 
tion, the hypodermic injection of ergot or ergotin, the intra- 
uterine injection of hot water, or the introduction of a large 
tampon of iodoform or sterile gauze. Herman's method of 
continual manual compression of the uterus and compression 
of the abdominal aorta may be tried in extreme cases. Trac- 
tion on the icervix with volsella-forceps will often control the 
bleeding. Bleeding from the lower birth-canal must be con- 
trolled by the introduction of sutures. 

What is a tampon? How is it made and when is it 
properly used? What precautions are to be observed in 
its use? 

A tampon is a plug of cotton, gauze, wool or oakum used 
to stop some canal or compress a bleeding surface. It may 
be made by passing a string around a portion of the substance 
used, or it may consist of a long strip of material packed in 
firmly. It is indicated in obstetrics in excessive hemorrhage, 
as from placenta prsevia, relaxation of the uterus, or lacera- 
tions of the lower birth-canal. Care must be taken to see 
that the material used is thoroughly aseptic, and that the 



OBSTETRICS AND GYNECOLOGY. 483 

cervix and vagina are not so distended as to give entrance to 
air, whereby air-embolism may be induced. 

Differentiate eutocia and dystocia. Mention important 
varieties of the latter. 

Eustocia is normal or easy labor ; dystocia is abnormal, diffi- 
cult, or painful labor. Dystocia may consist in precipitate, 
retarded or obstructed labor, or labor complicated by fetal 
or maternal accidents, or by gross fetal or maternal disease. 
This includes hydrocephalus, malpositions and malpresenta- 
tions of the fetus, eclampsia, rupture of the uterus, prolapse 
of the cord, placenta prsevia, premature separation of the 
placenta, contracted pelvis, and various other conditions on 
the part of the fetus and mother. 

Give the causes of dystocia in the uterus, vagina, pelvis, 
and vulva. 

In the uterus as causes of dystocia may be mentioned the 
presence of tumors, double uterus, abnormal placental attach- 
ment, rupture of the uterus, and malpresentations of the 
fetus. In the vagina, septa, stenosis, and tumors; in the 
pelvis the various forms of contraction and bony and carti- 
laginous tumors ; in the vulva, hematomata, stenosis or atresia, 
imperforate hymen and tumors. 

Describe the difficulties which arise during labor from 
malposition of the fetal head. 

If the head lie transversely in the superior strait it will 
become partially extended, and cause larger diameters of the 
fetal skull to engage than in vertex presentations. This wall 
cause prolongation or absolute blocking of the labor. Exces- 
sive moulding and disfiguring of the fetal presentation will 
follow; forceps or version may be necessitated. If the face 
or brow present, labor may become impossible. 

How would you diagnose and manage a case of occipito= 
posterior presentation? 

In this case the vertex may be directed to the right or to 



484 OBSTETRICS AND GYNECOLOGY. 

the left sacro-iliac synchondrosis, and the sagittal suture will 
lie in the right or left oblique diameter respectively. The 
R. 0. P. is the most common of the occipito-posterior presen- 
tations. The case must be treated by laying the woman upon 
the side toward which the fetal back is directed in order to 
secure full flexion of the head, and thereby prevent backward 
rotation of the occiput. A firm binder should be applied, 
and quinine must be administered and delivery accomplished. 
As the head rotates anteriorly, the instruments must be with- 
drawn and reapplied in the new oblique diameter. 

How would you diagnose and deliver an occiput in the 
hollow of the sacrum? 

In this icase the small fontanel will be felt in the median 
line posteriorly and the large fontanel high up anteriorly. 
The ears may be palpated to either side in the transverse 
diameter. Labor will be blocked. Forceps must be applied, 
and as traction is made the handles must be elevated in order 
to overflex the head. When the occiput begins to greatly dis- 
tend the perineum and the brow comes under the symphysis, 
the handles must be carried downward, and the head deliv- 
ered with the face emerging from under the symphysis. 

Describe in detail the proper procedure when the head 
is movable above the brim of the pelvis but does not en= 
gage. 

There is probably some degree of pelvic flattening present. 
If so, the head will lie transversely. Axis-traction forceps 
should be applied and the head made to engage. If this be 
impossible, and the contraction of the pelvis is not too great, 
podalic version is indicated. In more extreme degrees of 
contraction Cesarean section must be performed. 

Give the frequency, causes, diagnosis, prognosis, treat= 
ment and dangers to the fetus in pelvic presentations. 

Pelvic presentations of the fetus occur in about 3 per cent, 
of all cases of labor. The causes of breech presentations are 



OBSTETBICS AXD GYXECOLOGY. 485 



reversal of the shape of the fetus or of the uterine cavity, 
hydrocephalus, fibroid tumors of the uterus, prematurity of 
the fetus, hydramnios. fetal monstrosities, and multiple preg- 
nancy. In these cases the fetal head is freely movable and 
high up in the abdominal cavity, the fetal heart-sounds will 
be heard above the umbilicus and to either side. Vaginal 
examination shows an absence of a hard and protuberant pre- 
sentation ; the presentation is high up. and the bag of waters 
long and finger-like. If the membranes have ruptured, a dis- 
charge of meconium will be noted. The prognosis is serious 
for the fetus. Thirty per cent, of these babies perish from 
asphyxia or injury to the head and neck in delivery. The 
treatment consists in non-action until the birth of the umbil- 
icus; then there must be speedy extraction of the after-- 
coming head in order to avoid fetal death. 

Describe the management of an impacted breech pre= 
sentation. 

If the breech become impacted, attempts may be made to 
decompose it by Goodell's method, viz.. the dragging down 
of one leg. upon which traction is made. If this does not 
succeed, axis-traction forceps may be applied over the pelvis ; 
this is a very efficient method. Other methods consist in the 
use of a fillet around the waist and thighs, and in dead babies 
the blunt hook over one thigh. 

Give the frequency, causes, mechanism and treatment 
of face presentation, L. M. A. position. 

Face presentation occurs in about U per cent, of all cases 
of labor. It results from anything which will prevent thor- 
ough flexion of the head, such as an enlarged thyroid or 
thymus gland or a prominent thorax, or anything that will 
disturb the relationship existing between the long axes of the 
body and head of the fetus, as dolichocephalus. The mech- 
anism consists in full extension and moulding, descent of the 
chin to the pelvic floor, anterior rotation to the symphysis 
under which it lodges, and birth of the head by a process of 



486 OBSTETRICS AND GYNECOLOGY. 

flexion; the shoulder and hip then rotate from the opposite 
side, and the rest of the mechanism is the same as in vertex 
presentations. If the chin be anterior the labor will probably 
be easy, since small diameters present. If the head sticks, 
forceps may be applied and the chin drawn down, after which 
labor will proceed. 

Give the diagnosis of face presentation before and after 
rupture of the membranes. 

Before rupture of the membranes the presentation will be 
noted as high; there is an absence of the dome-like projection 
of other head presentations; the features of the face may be 
detected. After rupture of the membranes the examining 
finger can be introduced into the mouth, when, if the child 
be living, reflex closure of the gums will be noted. 

How may a face presentation be converted into a vertex 
presentation? 

If labor have not yet begun, Schatz's method of cephalic 
version, performed by external manipulation alone, may be 
attempted. With one hand firm pressure is exerted against 
the anterior portion of the fetal neck, while counter-pressure 
is made with the opposite hand upon the occiput, at the same 
time an assistant pushes the breech in the direction in which 
the face is looking; the head is thus flexed upon the body 
and the vertex caused to present. If labor has already be- 
gun, and the os is dilating, Baudelocque's method of cephalic 
version, the "ratchet method," may be attempted under 
anesthesia. One hand is placed against the face, and while 
the thumb pushes the chin upward the fingers hook over the 
occiput and drag it down; an assistant at the same time 
carries the breech over to the side toward which the face is 
directed. 

What is the mechanism of a mento=posterior position, 
and what the complications? 

A persistent mento-posterior position is an absolutely im- 



OBSTETRICS AND GYNECOLOGY. 487 

possible labor, and therefore there is no mechanism. For 
labor to advance the chin must strike the pelvic floor. The 
lateral height of the pelvis is 3% inches (9 cm.), while the 
length of the fetal neck is only 1% inches. The posterior 
height of the pelvis is 5 inches (12% cm.). In order for the 
chin to reach the floor in these cases it would be necessary 
for the thorax and occiput (18% cm. or 7 inches) to enter 
the superior strait simultaneously. No diameter of this strait 
could accommodate such a bulk. The uterus becomes tetanic 
in action, the head and shoulders become impacted, the child 
perishes, and the mother is exposed to the danger of uterine 
rupture. 

How should forceps be applied in a case of face pre= 
sentation? 

In the mento-occipital diameter, the chin being in apposi- 
tion with the heel of the bladder ; the forceps should be used 
only as rotators in mento-posterior positions. 

How would you manage a brow presentation? 

A brow presentation is an absolutely impossible case of 
labor. The occipito-mental diameter of the fetal head, 13% 
cm., attempts to engage, but can find no accommodation in 
the superior strait. The treatment consists in the perform- 
ance of cephalic version, bringing down the occiput and apply- 
ing forceps. If this be not possible, podalic version should 
be tried. In impacted cases with the child dead, craniotomy, 
with perforation through the bregma, becomes necessary. 

How would you treat a case of lateral presentation? 

Lateral presentations of the head, including the parietal 
eminence or the ear, should be treated by manual replacement, 
converting the presentation into a true vertex presentation. 
If this be impossible forceps may be applied or podalic ver- 
sion performed. 

Make a diagnosis of transverse presentation, and state 



488 OBSTETRICS AND GYNECOLOGY. 

how it should be managed. Give the frequency, causes, 
mechanism and management of such a case. 

A transverse, shoulder or trunk presentation occurs in 
about y 2 per cent, of all cases of labor. The causes are over- 
size of the fetal head, overgrowth of the entire fetus, fetal 
monstrosities, mobility of the fetus, hydramnios, multiple 
pregnancy, uterine deformities, undue obliquity of the uterus, 
uterine and pelvic tumors, placenta praevia, and traumatism, 
such as falls or jars. There is no mechanism for such a case, 
the labor being absolutely impossible. The condition may be 
recognized readily by external palpation, the child lying at 
right angles to the long axis of the maternal body. Vaginal 
examination reveals a high position of the presentation, and 
the shoulder or elbow may be palpated through the mem- 
branes. There is but one thing to do in all transverse pre- 
sentations, namely, podalic version under full anesthesia. 

How should a hand presentation be managed? What 
course would you pursue if you found an arm projecting 
from the vulvar orifice? 

This would indicate a cross-birth. The arm should be left 
alone, and podalic version performed. A tape may be tied 
around the wrist in order to prevent extension of the extrem- 
ity during the process of turning; if the tape be held taut 
the arm is carried in front of the face and descends with the 
shoulders. 

What are the causes of precipitate labor, what are its 
dangers, and what is the treatment? 

Precipitate labor may be caused by an excess in the expul- 
sive power of labor or a deficiency in the resistant powers. 
The dangers to the fetus are asphyxiation from rupture of 
the cord or premature detachment of the placenta and injury 
from a fall upon the floor or into a commode. The maternal 
dangers are hemorrhage, fatal syncope from sudden evacua- 
tion of the uterine contents, inversion of the uterus, lacera- 



OBSTETRICS AND GYNECOLOGY. 489 

tion of the cervix or perineum, and post-partum hemorrhage. 
The treatment of precipitate labor consists in a retardation 
of the advancing presentation in order to avoid the fore- 
going accidents. When the head is on the floor short forceps 
may be applied and the progress of the head arrested. 

What are the causes of delay in labor (a) on the part 
of the mother; (b) on the part of the child? 

The maternal causes of delayed labor are uterine inertia 
and obstruction in the birth-canal from any cause. The fetal 
causes are malposition and malpresentation, oversize, hydro- 
cephalus, fetal syphilis, fetal ascites, and other diseases caus- 
ing overgrowth of organs or distension of cavities. 

State the dangers and symptoms of a prolonged labor. 

The symptoms of prolonged labor are those of uterine in- 
ertia (see below). The dangers are, for the fetus, fatal com- 
pression of the brain-centers and intra-uterine respiration, 
with inspiration of liquor amnii or other substances. The 
maternal dangers are pressure-necrosis, the development of 
sepsis, exhaustion and death, and post-partum hemorrhage. 

Give the causes, diagnosis and management of uterine 
inertia. 

Uterine inertia is that condition in which the uterine con- 
tractions are irregular, weak and ineffectual, not sufficing to 
induce dilatation of the os or expulsion of the fetus. The 
causes are idiosyncrasy, advanced age of the woman, multi- 
parity, emotion, temporary paralysis of the uterine muscles, 
as from over-distension, weakness of the muscle, and any 
cause preventing the hydraulic action of the liquor amnii. 
The symptoms are weak, infrequent and irregular contrac- 
tions, slight suffering, and slow or no advance of the fetal 
presentation. In the first stage of labor quinine may be 
administered in large doses and a firm abdominal binder 
applied ; strychnine during the last weeks of pregnancy has a 
tendency to increase the efficiency of the uterine contraction. 



490 OBSTETRICS AND GYNECOLOGY. 

In the second stage of labor forceps should be applied, and 
after the delivery of the child ergot must be used in large 
doses to prevent post-partum hemorrhage. 

What is the proper management of rigidity of the os 
uteri in labor? 

Rigidity of the cervix is common in elderly primiparse and 
in those suffering from uterine inertia; it may result from 
cicatrices and from cancerous involvement of the cervix. The 
treatment consists in the administration of large doses of 
chloral, hot vaginal douches, anesthesia, cocaine to the cervix,, 
digital divulsion, or incision. 

Give the diagnosis and treatment of hour=glass contrao 
tion of the uterus. 

Hour-glass contraction of the uterus is an irregular con- 
traction of the uterus, usually occurring before the escape of 
the placenta, which is retained above the ring of Bandl. The 
latter appears to be in an abnormal state of contraction. 
Digital exploration traces the cord up to the contracted ring. 
Treatment consists in digital divulsion of the contracted por- 
tion, followed by removal of the placenta and antisepsis of 
the cavity. 

Give the causes, symptoms, diagnosis and prognosis of 
rupture of the uterus during labor, and state how such an 
accident should be managed. 

The exciting causes of uterine rupture during labor are 
some insuperable obstruction to the delivery of the child, mis- 
directed or injudicious efforts at version, and tetanic action 
of the muscle of the upper uterine segment from the admin- 
istration of ergot. The predisposing causes are diminished 
tonicity of the uterine walls, undue prolongation of labor, 
fatty degeneration of the uterine muscle, or a previous opera- 
tion upon the uterus. The site of the rupture is usually in 
the lower uterine segment. The symptoms are sudden, acute, 
lancinating pain, immediate collapse, signs of internal hemor- 



OBSTETRICS AND GYNECOLOGY. 491 

rhage, an anxious expression, pallor, rapid running pulse, 
recession of the presenting part, the presence of two distinct 
tumors, and the ability to detect the rent by the examining 
finger. The prognosis is grave ; the maternal mortality is 55 
to 60 per cent. The treatment consists in immediate evacua- 
tion of the uterine contents, and if the tear has not com- 
pletely perforated the uterus the patient may be watched 
carefully for the development of sepsis. In complete lacera- 
tion an abdominal section must be performed and the tear 
sutured aseptically. 

Make a differential diagnosis of intrauterine and extra= 
uterine hemorrhage. 

In the former there will be noted either a free escape of 
blood per vaginam or a rapidly distending uterine body, 
associated with the symptoms of hemorrhage. In the latter 
the signs of concealed hemorrhage will be present, and vag- 
inal examination will reveal the presence of a boggy mass in 
the abdominal cavity and in Douglass' cul-de-sac. 

Give the diagnosis, causes and treatment of pelvic hema= 
tocele. 

Pelvic hematocele results generally from rupture of an 
extra-uterine pregnancy. It may result from rupture of 
varicose veins in the broad ligament. It is recognized by the 
signs of concealed hemorrhage and a rapidly increasing boggy 
mass in Douglass' cul-de-sac. The only treatment is abdom- 
inal section and ligation of the bleeding point, 

Name three important forms of hemorrhage occurring 
in obstetric practice. 

Antepartum hemorrhage, or that occurring in the last tri- 
mester of pregnancy. This may be due to placenta previa 
or premature separation of the placenta. Intrapartum hem- 
orrhage is that occurring during the progress of labor, as in 
the case of uterine rupture or inversion of the uterus. Post- 
partum hemorrhage is that form occurring immediately after 
labor. 



492 OBSTETRICS AND GYNECOLOGY. 

What is placenta praevia? Name its causes, varieties, 
symptoms, dangers and management. 

Placenta previa is that condition in which the placenta is 
attached to the lower uterine segment, and presents in front 
of the fetus. It may be complete or central (placenta cen- 
tralis), lateral, marginal and parietal. The cause of placenta 
prasvia is unknown. It has been said to be due to uterine 
subinvolution, low fixation of the ovum, and downward 
growth of the decidua reflexa. There is but one symptom, 
namely, free and painless hemorrhage, occurring at decreas- 
ing intervals and in increasing quantity. The dangers are 
fetal and maternal death from asphyxia, hemorrhage, air- 
embolism, and septic infection. The treatment consists in 
rapid dilatation of the os and delivery of the fetus by ver- 
sion, or in the marginal form the application of the forceps 
and rapid engagement of the head. In the central variety 
the hand must be carried directly through the placenta. 

Mention two distinct methods of dilatation of the cervix 
uteri in obstetric practice. 

Edgar's method consists in bimanual stretching 'and par- 
alyzing of the cervical muscle. The index and middle fingers 
of both hands are introduced into the cervix, which is grad- 
ually but forcibly stretched in various directions. Another 
method is the use of bags, such as Barnes ' or those of Cham- 
pet ier de Ribes and Voorhees, 

What are the dangers of traction on the child and on 
the placenta? 

Traction on the cord may cause premature separation of 
the placenta. It may cause rupture of the cord or avulsion 
of the cord from the placenta, or it may result in inversion 
of the uterus. 

What is inversion of the uterus, what its causes and 
symptoms, and how is it recognized? 

By this term is meant a turning of the uterus inside out, 



OBSTETRICS AND GYNECOLOGY. 493 

either completely or in part. It may occur spontaneously, 
the uterine fundus or placental site being temporarily par- 
alyzed and sinking in ; it may result from traction on the- 
cord, the placenta not yet having separated ; or it may follow 
suction from close fitting of the detached placenta in the lower' 
uterine segment and traction being made upon the cord. 
Other causes are vigorous Crede manipulations and violent 
bearing down on the part of the woman. The symptoms are 
acute pain, hemorrhage, shock, bearing down, and the appear- 
ance of a tumor in the vagina. This may be mistaken for a 
uterine polyp, but the surface of the latter will be covered 
with the normal uterine mucosa, while the inverted uterus 
will show decidual tissue and the site of the placental attach- 
ment ; the orifices of the Fallopian tubes may also be detected. 
The treatment of acute inversion consists in immediate re- 
placement, followed by the introduction of a strip of gauze 
to prevent recurrence. 

Give the causes, pathology, symptoms and prognosis of 
eclampsia gravidarum, and state the relative frequency in 
primiparae and multiparae. What is the treatment? 

Puerperal eclampsia or puerperal convulsion is a convul- 
sive or epileptiform seizure appearing suddenly in a woman 
prior to, during or shortly after labor, and characterized by 
tonic and then clonic convulsions of the muscles, with albu- 
minuria, coma and death. The great majority of cases occur 
in primiparae — about 75 per cent. Other causes are heredity, 
climatic influence, multiple pregnancy, extreme anemia, and 
nervous excitability, all acting as predisposing influences. 
The true cause is the presence in the blood of toxins, prob- 
ably of hepatic origin, which cause a general arteriole con- 
traction ; as a consequence there follows an anemia of the base 
of the brain and a corresponding cortical congestion. The 
symptoms are fixing of the eyes, tonic contraction of the facial 
muscles {sardonic grin), lividity, rapid involvement of all 
the trunk muscles, distension of the superficial veins, and 



494 OBSTETRICS AND GYNECOLOGY. 

frothing at the mouth. The paroxysm lasts from y 2 to 2 
minutes. It is followed by increasing coma and a rise of 
temperature. The urine becomes loaded with albumin. The 
prognosis is grave; 30 per cent, of the women and 50 to 74 
per cent, of the children perish. The causes of maternal 
death are asphyxia, cerebral apoplexy, syncope, pulmonary 
edema, and exhaustion. The fetus dies of asphyxia. The 
prophylactic treatment is the 'treatment of the kidney of 
pregnancy. During the attack chloroform must be admin- 
istered. After the spasm, if the patient be plethoric, vene- 
section to the amount of 20-25 ounces may be performed, 
followed by the introduction of normal saline solution into 
the tissues. Croton oil 1 to 3 drops, chloral hydrate 30 grains 
by the rectum, and veratrum viride 15 drops of the fluid ex- 
tract hypo'dermically may be administered. A hot pack aids 
in the elimination of the poison. The uterus should be emp- 
tied as soon as possible in order to still further relieve the 
system. 

Give the danger=signals of impending eclampsia. 

Rapidly lessening amount of urates in the urine ; lessened 
urinary toxicity, the development of eye-symptoms, including 
muscse volitantes, scintillations and blindness, and neuralgic 
pains over the eyes, under the clavicles and in the epigastrium. 

In case eclampsia gravidarum appears before the end of 
the eighth month, how should it be managed? 

By dilatation of the os and removal of the child by forceps 
or version. The course of treatment already indicated should 
be adopted. 

What are the varieties of puerperal convulsions, and 
how are they differentially diagnosed? 

A puerperal woman may suffer from various convulsive 
seizures, including the true puerperal eclampsia. She may 
have an anemia or an hysteric convulsion, or one due to 
nervous irritability. A true epileptic convulsion may occur, 



OBSTETRICS AND GYNECOLOGY. 495 

but this is not accompanied by albuminuria, has not the same 
prodromata nor the rise of temperature, and there is, as a 
rule, a definite history of previous attacks. Meningitis is 
accompanied by vomiting, optic neuritis, opisthotonos, and a 
rise of temperature before the onset of the convulsion. 

When is curettage of the uterus justifiable in obstetric 
practice, and how should it be performed? 

Curettage is required whenever there has occurred a reten- 
tion of some of the products of conception either after abor- 
tion or labor. The best curet is the finger of the obstetrician, 
but if this will not answer, the dull curet may be employed 
or the placental forceps, under thorough asepsis and anti- 
sepsis. In curetting the uterine cavity the walls should be 
scraped systematically and without great pressure. The dan- 
gers are hemorrhage and perforation. 

Define puerperal mania. Give its etiology, symptoms 
and treatment. 

Puerperal mania is the most common form of puerperal 
insanity, or insanity occurring during the lying-in period. 
It may result from heredity, primiparity, anxiety, dystocia, 
and septic infection. Some authorities attribute all the cases 
to septic infection. The disease appears with alarming ab- 
ruptness. Without warning the patient becomes maniacal or 
wildly delirious, and suffers from the most peculiar hallu- 
cinations. A homicidal or suicidal tendency is common. 25 
to 35 per cent, of the cases die from exhaustion or from sep- 
ticemia, or remain permanently insane. The patient should 
be confined in a hospital and given nerve-sedatives, bromides, 
hyoscine, trional, sulfonal and tonics. Rest and mental diver- 
sion are essential. 

What hygienic precautions are necessary for a nursing 
child if the mother has sore nipples? 

If the nipples are fissured the child may suck in blood and 
suffer from hematemesis. It should temporarily be fed on the 



496 OBSTETRICS AND GYNECOLOGY. 

bottle or from a spoon, but returned to the breast as soon as. 
the nipple will permit. An artificial nipple may also be used. 

Give the management in a case of (a) flat or inverted 
nipples, and (b) cracked nipples. 

A flat or inverted nipple requires gentle traction and manip- 
ulation during the last weeks of pregnancy, or more powerful 
suction through a breast-pump. If this does not succeed an 
artificial nipple must be employed. Fissured nipples should 
be kept clean and dry, and anointed between the nursing with 
sweet oil.- In worse cases healing applications are necessary, 
as ichthyol in lanolin or glycerin, or 1 dram each of bismuth 
subnitrate and castor oil, compound tincture of benzoin, or a 
4 to 8 per cent, solution of silver nitrate after coeainization. 
The child should not nurse from these nipples. 

Give the varieties, pathology, symptoms and treatment 
of puerperal mastitis. 

Mastitis, or inflammation of the mammary gland, may be 
suppurative or non-suppurative. It is almost always due to 
septic infection occurring through a fissured nipple. Occa- 
sionally it may result from caking of the breasts or milk-stasis. 
The pathology consists essentially in an acute inflammation 
of the cellular tissue of the gland. The symptoms are acute 
pain, inflammation, reddening of the 'surface, induration, mal- 
aise, elevation of temperature, and headache. The treatment 
consists in hot compresses of lead-water and laudanum, the 
ice-bag, the application of a mammary binder, and ichthyol 
or belladonna locally ; the child should not nurse. The bowels 
should be opened. 

Give the symptoms and treatment of mammary abscess. 

If mastitis advances to suppuration the symptoms will 
change. This is most common in the third or fourth week of 
the puerperium. The pain becomes dull and throbbing ; rigor 
or chills are noted ; the fever becomes hectic in type ; the 
indurated portion of the breast becomes softer at a certain 



OBSTETRICS AND GYNECOLOGY. 497 

point, and fluctuation may be noted ; the surface of the gland 
■becomes edematous, livid and glazed. When the abscess is 
situated deeply in the areolar tissue just above the pectoral 
muscles a postmammary or submammary abscess results. In 
this case the pus is very apt to burrow, and the gland is raised 
from the chest and becomes protuberant. The treatment of 
abscess is early incision, the line of incision radiating from 
the nipple ; the wound should be bathed in mercuric chloride 
(1:4000) and packed with sterile gauze. 

What is the treatment of galactorrhea? 

Galactorrhea is an excessive flow of milk from the engorged 
breasts. It may be corrected by feeding the infant at regular 
intervals, and between the feedings the breast-pump may be 
employed to remove the excessive flow. Ergot may be admin- 
istered in small amounts, potassium iodide given in doses of 
10 grains three times daily, and belladonna ointment applied 
locally, or a 5 per cent, solution of cocaine in equal parts of 
glycerin and water. 

To what dangers in pregnancy and labor does gonorrhea 
of the mother expose her and her offspring? 

During pregnancy a gonorrheal woman may develop a pus- 
tube, which may rupture or cause an abortion and expose her 
to the development of septic infection. A gonorrheal woman 
is always in imminent danger of puerperal sepsis after the 
delivery of her child. The child is exposed to the danger of 
ophthalmia neonatorum. 

Give the sj'mptoms, treatment and prognosis of oph= 
thalmia neonatorum. State its causes and the means of 
prevention. 

Ophthalmia neonatorum is a purulent inflammation of the 
conjunctiva of the infant due to infection at birth by gonor- 
rheal virus contained in the uterine and vaginal discharges. 
It is very virulent, and frequently results in total loss of 
sight from perforation of the cornea and destruction of the 
32 



498 OBSTETRICS AND GYNECOLOGY. 

superficial tissues. The symptoms are reddening and edema 
of the palpebrge, agglutination of the lids, profuse purulent 
discharge, a bright-red appearance of the conjunctivae, and 
later ulceration and perforation of the cornea. The prognosis 
is good unless corneal ulceration occurs. The treatment is 
mainly prophylactic, and this consists in frequent vaginal 
douching during labor, and, immediately after the birth of 
the head, cleansing of the eyes with warm sterilized water, 
followed by the instillation of a few drops of a 2 per cent, 
solution of silver nitrate. After the disease has appeared the 
cleaning must be done hourly {Creole's method) with warm 
water, followed in alternate hours by mercuric chloride 1 to 
5000 to 8000, and a saturated solution of boric acid. Twice 
daily an application of silver nitrate 4 per cent, solution may 
be used. The well eye should be protected with a collodion 
dressing. 

Give the pathology of hydrocephalus. State how hy= 
drocephalus may be recognized before delivery, and how 
such a complication should be dealt with. 

Hydrocephalus is a collection of serous fluid at some point 
within the cerebral substance {internal hydrocephalus) or 
outside the brain-substance {external hydrocephalus), pre- 
venting closure of the fontanels and causing enlargement of 
the skull. It is probably a sequel of some obscure form of 
inflammation of the cerebral meninges. The vaginal finger 
detects bulging fontanels and widely separated sutures, both 
yielding the sensation of fluctuation. Occasionally crepita- 
tion may be noted. Abdominal palpation reveals an unusual 
size of the head. The treatment consists in aseptic puncture 
through a fontanel or suture; if this fails craniotomy is in- 
dicated. 

How may multiple (twin) pregnancy be recognized? 
State how it may complicate labor, and show how labor 
should be managed when this condition exists. 

A twin pregnancy may be recognized by the unusual size 



OBSTETRICS AND GYNECOLOGY. 499 

of the abdomen, by the presence of two distinct fetal heart- 
beats, heard best at different points of the abdominal sur- 
face ; there may be two distinct placental souffles, irregularity 
in the outline of the uterus, the presence of a number of fetal 
extremities or parts, and the ability to outline two fetuses. 
The dangers are uterine inertia, abnormal presentations, im- 
perfect development of the fetuses, the formation of mon- 
strosities, and locking of the babies. The first child present- 
ing normally, labor should proceed normally; after its birth 
the second child should be made to present in a proper man- 
ner, and then 1 dram of the fluid extract of ergot should 
be administered. Not infrequently a forceps-delivery is re- 
quired. 

What complications may arise in a twin labor, and how 
may they be overcome? 

Malpresentation and malposition are frequent and must be 
corrected. Locking of the heads requires separation of the 
chins, the application of forceps or decapitation. 

What is superfetation, and how does it take place? 

Superfetation is the supposed fertilization of an ovum when 
there is another from a previous ovulation in uterogestation. 
There is considerable doubt as to the possibility of such an 
occurrence. If it does occur it will probably take place 
within the first few days after the primary conception, i. e., 
before the formation of the decidua, The occurrence of 
superfetation at a more advanced stage in the development of 
the primarily fertilized ovum seems, however, to have been 
proved by remarkable cases reported by eminent men. 

What is meant by prolapse of the funis? When does it 
occur? What are its dangers? How would you manage 
such a case? 

Prolapse of the cord consists in the descent of a loop of 
the umbilical cord in advance of the presenting fetal portion. 
It occurs in certain malpositions and malpresentations of the 



500 OBSTETRICS AND GYNECOLOGY. 

fetus, in multiple pregnancy, in hydramnios with sudden 
escape of the liquor amnii, and in contracted pelvis when the 
fetal head does not properly fit into the superior strait. The 
danger is fetal death from asphyxiation due to pressure on 
the cord. The treatment consists in replacement of the cord, 
the woman resting in the knee-chest or Trendelenburg pos- 
ture. This may be accomplished by gravity, aided by the 
hand or by a respositor. If this fails, poclalic version may be 
performed or the child hastily delivered by forceps. 

What is premature respiration? 

The establishment of the function of respiration before de- 
livery of the child has been accomplished. This is due to the 
entrance of air into the birth-canal, and occurs in cases of 
dystocia or during the performance of version. The danger 
is insufflation of liquor amnii or clots, with the development 
of fetal pneumonia. 

How does constitutional syphilis in the parents affect 
the infant, and how can you detect its presence in the 
infant? 

The offspring of syphilitic parents is generally infected by 
the disease. Congenital syphilis will be shown by the follow- 
ing symptoms : Undersize of the fetus, delivery at term of a 
still-born baby, syphilitic pemphigus on the palms and soles, 
enlargement of the liver and glands of the body, catarrhal or 
white pneumonia, and a line of fatty tissue between the epi- 
physis and diaphysis of the long bones. If the child be born 
alive and apparently healthy it will develop a coryza or 
"snuffles" at the expiration of four or five weeks, followed 
by the appearance of eruptions over the body and the devel- 
opment of marasmus. 

Give the causes and treatment of umbilical hemorrhage 
of the new=born child. 

Primary omphalorrhagia results from loose ligature or 
laceration of the cord, and occurs immediately after birth. 



OBSTETRICS AND GYNECOLOGY. 501 

Secondary hemorrhage occurs at the time of separation of the 
cord, and is due to a dislodgement of the clots or to the 
hemorrhagic diathesis. The treatment consists in religation of 
the cord, the application of a firm compress with an astringent 
solution, the application of a firm plaster of Paris dressing, 
or of a figure-eight ligature applied over hare-lip pins. 

How would you decide whether a dead infant had been 
born alive? 

By the presence of air in the lungs (hypostatic test). 

What are the causes of still=birth, and how should a 
still=born child be treated? 

The causes of still-birth are various intra-uterine diseases, 
asphyxia from pressure on the cord or interference with the 
fetoplacental circulation, as in eclampsia or premature sepa- 
ration of the placenta, and traumatism during some obstetric 
operation. Such a child should be handled tenderly and be 
given a decent burial. The term "still-birth" should not be 
confounded with asphyxia neonatorum. 

Give the etymology and uses of the forceps, and name 
the conditions for their application, together with the 
rules therefor and precautions to be observed in the same. 

The obstetric forceps (a Latin word) is an instrument with 
two blades and handles for pulling, grasping or compressing 
the fetus. Its use is indicated by the presence of uterine 
inertia, minor degrees of pelvic contraction, threatened fetal 
or maternal death, and to correct malpositions of the fetal head. 
In order that the instrument may be applied the os must be 
dilated, the membranes ruptured, there must not be too great 
disproportion between the head and the birth-canal, the part 
should be engaged, and the labor must be possible. The left 
blade is always introduced first, and must be grasped in the 
left hand and carried to the left side of the patient. It must 
not be forcibly thrust in, but must be slightly rotated in order 
to accommodate it' to the pelvic and fetal curves. The blade 



502 OBSTETRICS AND GYNECOLOGY. 

that corresponds in name to the pelvic diameter in which the 
fetal presentation is lying must be pried forward in order to 
grasp the fetal head on the sides. 

Describe the common varieties of obstetric forceps. 

A short forceps is one in which the blades are attached 
directly to the handles without the intervention of a shank; 
it has the cephalic curve only, and is used only when the 
head is on the pelvic floor (low forceps operation) . The long 
forceps is one in which a shank is placed between the handles 
and the .blades ; it has a pelvic curve, as well as the cephalic. 
It may be used at the superior strait, but usually applied 
to the head in the pelvic cavity (median forceps operation) . 
The axis traction forceps is a long forceps, in which, by an 
appliance or supplementary handle attached to the under 
surface of the blades, the traction force is constantly exerted 
in the line of the axis of the parturient canal. It is used at 
the superior strait (high forceps operation) . 

Describe the position of patient and physician for the 
readiest means of applying the forceps. 

The patient lies upon her back in the lithotomy position, 
with the limbs flexed and the buttocks over the side of the 
bed. The physician sits on a chair between the thighs, which 
are separated and held by assistants. 

In what direction should traction be made when the 
fetal head is in the cavity of the pelvis? 

At first downward and outward, then upward and back- 
ward. 

What powers may be exerted by the forceps? 

The forceps are generally used as tractors. They may be 
employed as levers, rotators, and compressors. 

What are the dangers in the use of forceps, and how 
are such dangers to be avoided? 

The dangers are slipping of the instrument, septic infec- 



OBSTETRICS AND GYNECOLOGY. 503 

tion, laceration of the cervix and soft tissues, and fatal com- 
pression of the fetal head. If applied gently, without force, 
and in the proper (less) diameters of the fetal skull, and if 
thorough asepsis be employed, these dangers may be obviated. 

Describe the technic of the high forceps operation. 

The instrument (axis-traction forceps) must be introduced 
through the cervix, and applied to the head in the best diam- 
eter possible. The grip is a vicious one, because a large diam- 
eter must be seized and there is danger of slipping. Traction 
is made well down at first, and as the head descends and the 
upper handles of the instrument rise the extra handles must 
be raised in order to keep the two handles together. When 
the head is low enough the instrument should be withdrawn 
and reapplied in a better position, or a simple instrument 
used. 

Describe the occasion for the application of the forceps 
in the inferior strait. 

This is a low operation. The blades are introduced in the 
manner already described, and traction made. outward and 
downward until the floor is reached. The head is then pulled 
upward and outward and then upward and backward until 
it emerges through the vulvar orifice. The instrument in the 
last stage of delivery is grasped in the right hand only, as a 
dagger would be held, and the left hand spans the perineum 
in order to regulate the degree of distension. 

Describe the use of the forceps in the occipito=posterior 
position. 

This is a double forceps-operation. The occiput generally 
lies in the right oblique diameter (R. 0. P.). After applying 
the forceps in the manner already described traction is made 
downward and outward until the head impinges upon the 
pelvic floor. In the intervals of relaxation a certain amount 
of anterior rotation will take place. This will carry the occi- 
put through the transverse and into the left oblique diameter. 



504 OBSTETRICS AND GYNECOLOGY. 

The forceps must then he removed and reapplied in the new 
diameter to prevent inversion of the instrument. The final 
traction and delivery are as in the ordinary anterior forceps- 
delivery. 

What indications would lead you to insert a hand into 
the uterus, and what precautions should you observe? 

Failure of the placenta to descend, active post-partum 
hemorrhage, and the necessity for the performance of version 
are the indications for the introduction of the hand into the 
uterus. Thorough asepsis and antisepsis must be observed, 
and the hand must be anointed with an antiseptic ointment. 

Define version. Give the varieties, indications and dan= 
gers of version, together with the preliminaries and the 
method of operating. 

Version or turning is an obstetric operation whereby by 
manual efforts the position of the fetus in utero is altered so 
that one extremity of the fetal ellipse is made to take the 
place occupied by the other 'extremity or by some portion of 
the trunk. The varieties of version are : 1. Cephalic, in which 
the head is made to present; 2. Pelvic, in which the breech is 
caused to present at the superior strait; and 3. Podalic, in 
which one or both feet are grasped and drawn down into the 
parturient canal. The indications for version are malposition 
of the head and malpresentations, minor degrees of pelvic 
contraction, placenta praevia, anything indicating speedy de- 
livery of the child, as threatened fetal or maternal death. 
The dangers of the operation are the introduction of septic 
matter or of air, with the production of air-embolism, rupture 
of the uterus, laceration of the cervix, and serious fetal in- 
jury. The patient should be anesthetized, and every anti- 
septic precaution observed. The membranes should not be 
ruptured until the hand is ready to be introduced. One foot 
should be grasped with the heel in the palmar surface and the 
child gently turned to avoid undue distension of the lower 
uterine segment. After the body is turned the case is treated 
as a breech presentation. 



OBSTETRICS AND GYNECOLOGY. 505 

Compare version with the employment of forceps, and 
state when each is preferable. 

Version is a shorter operation, and one that is to be pre- 
ferred when haste is required. The dangers of sepsis are 
greater than in the use of forceps, and also the danger of 
uterine rupture. Version should be used when the forceps 
fail to engage the head in minor degrees of pelvic contraction. 
Version cannot be employed when engagement has occurred 
or when there is a high position of Bandl's ring. 

Describe symphyseotomy, and give the indications for 
its performance. 

Symphyseotomy or division of the pubic symphysis is an 
extremely limited operation. It should be done, if done at 
all, only in those cases of pelvic contraction in which the con- 
jugate diameter of the superior strait measures from 7 to 8 
cm. The operation of choice is the indirect method, in which 
an incision iy 2 to 2 inches long is made above the symphysis 
in the median line, and after separation of the muscles the 
G-albiati knife is passed down beneath the symphysis and the 
bone divided from below upward and from within outward. 
As the symphysis separates gauze is packed in to arrest hem- 
orrhage. The forceps is then applied and the child extracted. 
After delivery the wound is closed and the bones held in ap- 
position by means of a firm pelvic binder. 

Define embryotomy and craniotomy, and give the indi= 
cations for and method of operating in each. 

Embryotomy is any mutilating operation upon the fetus. 
It includes decapitation or beheading of the fetus, amputa- 
tions of the fetal extremities, evisceration, or removal of the 
viscera piecemeal, and craniotomy, or opening of the fetal 
skull, with evacuation of the brain. The technic of craniot- 
omy is as follows : Vaginal asepsis, fixation of the head and 
scalp with volsella-forceps, perforation through a suture or 
fontanel, enlargement of the perforation, disorganization of 
the brain-mass, decerebration by intra-cranial injections of 



506 OBSTETRICS AND GYNECOLOGY. 

warm carbolized water, crushing of the skull, and extraction 
of the head by the craniotractor. 

Give the various steps in embryotomy in the transverse 
presentation. 

If the fetus presents by the back, the operation of spondy- 
lotomy or division of the vertebras is indicated, followed by 
evisceration or by delivery of the fetal body doubled upon 
itself. Spondylotomy or raehiotomy is performed by means 
of scissors, as is also evisceration. Occasionally in impacted 
shoulder presentations the operation of decapitation will be 
indicated. This can be accomplished by means of the blunt 
or the sharp hook or by scissors. The body is readily re- 
moved, and the head must then be grasped by forceps, crushed 
and extracted. 

Give the condition requiring Cesarean section or hys= 
terectomy, and describe a modified form of the operation. 

Cesarean section or delivery of the child through an ab- 
dominal and uterine incision is indicated in grave degrees of 
pelvic contraction, in labor obstructed by tumors of the uterus 
and pelvis, in irreducible vaginal tumors, in rupture of the 
uterus, and in sudden maternal death. The original Cesarean 
section, in which an incision was made into the uterine wall 
and the child extracted, has been modified by Sanger as fol- 
lows: The abdomen is opened in the median line, the uterus 
delivered and towels packed around it. Then while the uter- 
ine arteries are controlled by an assistant an incision is made 
into the uterus and the child and placenta extracted. The 
uterine cavity is cleaned out and sutures introduced to close 
the uterine incision, after which the abdominal wound is 
closed. 

Define Porro's operation, state when it is applicable, and 
1 describe the method of its performance. 

The Porro operation or celiohyst erect omy consists in the 
extirpation of the uterus and its appendages after the ex- 



OBSTETRICS AND GYNECOLOGY. 507 

traction of the fetus, as in the simple Cesarean section. The 
indications for this operation are extreme degrees of pelvic 
contraction, marked atresia of the cervix, vagina or vulva, the 
presence of large bony growths in the pelvic canal, large 
fibrous or myomatous tumors of the uterus, extensive rupture 
of the uterus, with involvement of adjacent structures, a re- 
laxed and flabby condition of the uterus after the section, 
and a septic condition of the uterus, with threatened general 
septic infection. The operation is the same up to extraction 
of the child. The ovarian and uterine arteries are then li gated 
and the uterus amputated at the cervical junction. The case 
is then treated as an ordinary abdominal section. 

What complications in labor justify abdominal section? 
Give the technic of the operation. 

The conditions that indicate Cesarean section, rupture of 
the uterus, retrodisplacement of the uterus with incarceration, 
extra-uterine pregnancy, labor complicated with tumors, grave 
septic infection of the uterus, appendages or broad ligament, 
all indicate abdominal section. The technic is that of Cesa- 
rean section with or without the removal of the uterus. 

Describe the malformations of the uterus. 

Owing to failure of development of the ducts of Miiller we 
have varying degrees of double uterus. The slightest degrees 
are known as uterus incudiformis and uterus cordiformis. 
From these minor degrees the uterine deformity may advance 
through the stages of uterus septus, subseptus, partitus, bi- 
partitus, bilocularis and senvipartitus. In the uterus bicornis 
the two tubes unite below, but are separated above. The 
uterus unicornis results from a lack of development of one of 
the Miillerian ducts, its fellow undergoing the normal process 
of evolution. 

Describe and differentiate anteversion, retroversion and 
prolapsus of the uterus. State the obstetric significance 
of each. 

Anteversion of the uterus is a bending of that organ for- 



508 OBSTETRICS AND GYNECOLOGY. 

ward ; retroversion is a bending backward ; prolapsus is a fall- 
ing down or descent of the organ. Anteversion may prevent 
a rising of the uterus if the organ be fixed, and so interfere 
with pregnancy. Retroversion of a pregnant womb may re- 
sult in incarceration with serious results. Prolapse does not 
as a rule interfere with gestation; the uterus returns to its 
normal position as gestation advances. 

Mention the symptoms and give the management of 
long=retained excretions due to imperforate hymen. 

In addition to menstrual suppression there will be noted 
cramp-like pains and a steadily growing cystic tumor in the 
median line of the abdomen. Palpation will elicit pain. 
Vaginal examination will show the imperforate condition of 
the hymen. The treatment consists of thorough asepsis, fol- 
lowed by cervical incision into the hymen. As the tarry fluid 
escapes a two-way catheter should be introduced and an 
antiseptic solution allowed to flow into the uterus in order to 
prevent shock from sudden evacuation and to prevent septic 
infection. 

What is vaginismus? How may it be recognized and 
treated? 

Vaginismus is painful spasm of the vagina and vulva. It 
results from rigid hymen, fissure, and other local conditions, 
and appears at the time of coitus or digital exploration. It 
is best treated by dilatation under anesthesia. 

What method should be employed to dilate the non= 
pregnant uterus, and under what circumstances is the 
operation justifiable? 

The best method of dilating the uterus is the use of the 
dilator of Goodell or Wathens, the glove-stretching apparatus. 
This is required whenever there is stenosis of the cervical 
canal, or as a preliminary step to the operation of curettage. 



OBSTETRICS AND GYNECOLOGY. 509 

Is ventrofixation of the uterus justifiable? If so, state 
under what circumstances, and describe the operation. 

It is a safe and proper operation for the correction of 
retro-displacement of the uterus in women past the child- 
hearing period. An abdominal opening is made, the uterus 
is brought forward, and a stitch is passed through the peri- 
toneal and subperitoneal tissues on one side of the incision, 
then through the fundus of the uterus on a line with the 
Fallopian tubes and through the corresponding tissues on the 
other side. A second suture must be passed a little back of 
this and firmly secured. The abdominal wound is then closed. 

Under what conditions may shortening of the round 
ligament become justifiable, and how should the operation 
be performed? 

Shortening of the round ligament may be performed when 
there is a retrodisplacement of the uterus. It is best per- 
formed by Wylie's method or some other of the intraperi- 
toneal methods, the ligaments being folded upon themselves 
or implanted further back upon the uterus. Alexander's 
operation is shortening of these ligaments in the inguinal 
canals. 

Define salpingitis, state its causes and pathology, and 
give its management. 

Salpingitis is inflammation of the Fallopian tubes. It may 
be septic, gonorrheal, or tuberculous in origin, or merely a 
catarrhal condition. The mucosa swells, secretes a fluid, and 
if the edges of the fimbriae adhere a retension-cyst is formed. 
The treatment may be derivative, and consist in purgation, 
with local applications to the cervix and vaginal vault, or 
abdominal section may be performed and the appendages re- 
moved. 

Give the pathology of (a) hydrosalpinx, (b) hematosaN 
pinx. Give the diagnosis and treatment of each. 

Hydrosalpinx, or a watery collection in the tube, results 



510 OBSTETRICS AND GYNECOLOGY. 

from an old pyosalpinx or purulent collection. The pyogenic 
membrane has become destroyed, and the fluid slowly assumes 
the watery nature. Hematosalpinx, or blood in the tube, re- 
sults almost invariably from an extra-uterine pregnancy. The 
treatment of each is excision. The diagnosis is made by the 
presence of a sensitive tumor in the situation of the tube, with 
pain on the affected side. 

Define endometritis, and give its causes, varieties and 
treatment. 

Endometritis, or inflammation of the lining membrane of 
the uterus, may be septic, gonorrheal, traumatic, catarrhal or 
tuberculous in origin, and occur as a glandular or as an inter- 
stitial affection, or as both combined. It may be treated by 
local applications, depletion, curettement, intra-uterine appli- 
cations, or by excision of the uterus. 

Give the causes of pelvic inflammation, and state its 
relation to involvement of the ovary. 

Pelvic inflammation is generally septic or gonorrheal in 
origin. It may result from exposure to cold or wet or from 
abrupt stopping of the menstrual discharge. If active and 
virulent or long continued there follows a thickening and 
chronic inflammation of the ovarian capsule, which will re- 
sult in follicular cysts forming in the ovarian stroma from 
inability of the Graafian follicles to rupture. 

Give a differential diagnosis between ovaritis and ova= 
ralgia. 

Ovaritis, or inflammation of the ovary, is associated with 
all the symptoms of pelvic inflammation, including pain, leu- 
korrhea, hemorrhage, menstrual disturbance, and swelling of 
the ovary or tumor-formation. There will also be general 
symptoms, as fever and prostration. Ovaralgia is neuralgia 
of the ovary, and may exist independently of any appreciable 
local lesion. It is more apt to occur at or near the menstrual 
period. 



OBSTETRICS AND GYNECOLOGY. 511 

Give the pathology and treatment of an ovarian cyst. 

An ovarian cyst may be follicular, as already described. It 
may be a multilobular cyst arising from rudimentary Graafian 
follicles, and consisting of two or more loculi or compart- 
ments; it may be a unilocular cyst springing from the paro- 
varium, or it may be a papillary growth arising in the vertical 
tubules of the paroophoron. Whatever its origin and path- 
ology, it should be removed by abdominal section. 

Give a description of cystocele and rectocele. State 
how each may complicate labor, and what should be done 
in the arising contingency. 

Cystocele is a prolapse of the anterior vaginal wall and 
posterior bladder wall; rectocele is a prolapse of the pos- 
terior vaginal wall and anterior rectal wall. Both cystocele 
and rectocele encroach upon the calibre of the vagina, and 
may be caught by the advancing fetal head either arresting 
its progress or being pushed before the head; in the latter 
case the submucous tissue is torn and the vaginal prolapse 
made worse. The treatment consists in applying forceps to 
the head and drawing it over the relaxed vaginal walls. 

How would you diagnose cystic degeneration of the 
ovaries from other forms of disease which simulate it? 

From ascites ovarian cyst may be distinguished by the cen- 
trally situated tumor, the area of central dulness with coronal 
resonance, the immovability of the tumor, and the protub- 
erant abdomen when the woman assumes the dorsal position. 
In ascites the abdomen flattens and the flanks bulge when the 
woman lies upon her back; a change of position causes a 
corresponding change in the area of dulness; fluctuation is 
marked; there is an area of central resonance with coronal 
dulness, and an associated grave organic disease may be de- 
tected. In phantom tumor the percussion-note is hyper- 
resonant, and examination under an anesthetic reveals the 
true condition. 



512 OBSTETRICS AND GYNECOLOGY. 

Give the early diagnosis and the treatment of cancer of 
the uterus. 

A recurrence of bleeding after the menopause ; an angry 
appearance of the cervix, which bleeds on the slightest touch ; 
a peculiar hardness of the mucous membrane due to cellular 
infiltration; an acid and irritating discharge, which may or 
may not be fetid, and dull sacral pains would lead to the 
suspicion of cancer. A microscopic examination would then 
complete the diagnosis. The only treatment consists in total 
extirpation of the uterus. 

Give the diagnosis and treatment of anemia and ch!o= 
rosis. 

Chlorosis is the "green sickness" of young girls. These 
girls are generally stout and well nourished, but present a 
peculiar green color; they suffer from nosebleed not infre- 
quently and attacks of vertigo and syncope. In true anemia 
there is an extreme pallor, with marked diminution in the red 
blood-corpuscles and hemoglobin and more or less wasting. 
Anemia is generally associated with some grave organic dis- 
ease. The treatment of both conditions consists in good food, 
change of scene, rest and tonics, including iron, strychnine 
and arsenic. 

What are the symptoms and treatment of amenorrhea? 

Amenorrhea is a total suppression of the menstrual flow. 
It is generally associated with anemic conditions, and may 
be accompanied by leukorrhea and vague pelvic pains. The 
treatment consists in tonics, good food, and the use of iron, 
oxalic acid, potassium permanganate, manganese, and the 
other so-called emmenagogues. 

What is the menopause, and in what manner would you 
explain the theory that it is a critical period in a woman's 
life? 

The menopause is the cessation of the phenomenon of men- 
struation, occurring usually at the age of 43 to 45. At this. 



OBSTETRICS AND GYNECOLOGY. 513 

time the ovarian influence ceases, and because of the tendency 
to the development of obesity and of uterine cancer at or 
after this period it has long been regarded as a critical period 
in the life of the woman. Various forms of insanity may 
also develop at this time. The post-climacteric diseases may 
assume a very serious aspect. 

Enumerate the perils of premature parturition. 

Premature labor subjects the woman to the dangers of 
hemorrhage from partial detachment of the placenta, cervical 
laceration because of rigidity of the parts, and sepsis from 
retention of placental debris. 

What are the conditions liable to produce sepsis after 
abortion? 

Imperfect expulsion of the product of conception and the 
necessity in many cases of digital assistance. 

Before the head engages, how would you convert an 
L. O. P. into an L. O. A. position? 

If possible by the position of the mother, who should lie 
upon the left side. If this fails, the head may be rotated 
forward by the hand or by forceps applied to the sides and 
gently turned, not, however, reversing their normal position 
in the pelvis. One blade of the forceps, the vectis, may be 
employed for the purpose in suitable cases. 

What injuries may happen to the vagina and rectum 
during labor, and how may they be avoided? 

The vaginal walls may be pushed or drawn ahead of the 
advancing part and partially detached from their support; 
they may be cut or torn by the blades of the forceps, which 
may also cut through the rectovaginal septum and produce a 
complete perineal laceration. These accidents may be pre- 
vented largely by preservation of the bag of waters as long 
as possible, by thorough lubrication of the parts, and by the 
proper use of the forceps when these become necessary. 
33 



514 OBSTETRICS AND GYNECOLOGY. 

Describe the method of applying forceps in R. O. A. 
presentation. 

The head lies in the left oblique pelvic diameter ; therefore 
the left blade first introduced is pried forward until the blade 
rests over the upper fetal ear, the handle of the instrument 
looking downward and outward to the operator's left. The 
right blade is then introduced and depressed without rota- 
tion until it fits into the slot of the other blade. 

Describe the operation in detail for the immediate re= 
pair of complete laceration of the perineum. 

After cleansing the parts, the patient being under an anes- 
thetic, a stitch is passed well behind the anal orifice and 
toward the median line with an outward sweep, so as to 
embrace the retracted sphincter fibers; it is then carried up 
to the apex of the tear and caused to traverse a similar course 
upon the other side of the fissure, emerging at the point of 
introduction. A second stitch is then introduced at the point 
of retraction of the outermost sphincter-fibers and carried in 
and toward the apex of the tear, traversing a similar course 
on the other side to emerge at the outermost retracted 
sphincter-fibers of that side. These two stitches close the 
sphincter. The perineum above is then closed by transverse 
sutures introduced in the usual manner. If the rectal septum 
is torn, it must first be closed by a running catgut suture. 

Give the mechanism of delivery of a R. O. P. presen= 
tation. 

After great labor-pains the head descends until the occiput 
strikes the pelvic floor high up posteriorly ; it is then rotated 
anteriorly through % of a half circle until it rests under the 
pubic symphysis. While doing this the shoulders rotate high 
up in the false pelvis from right to left until they rest in the 
right oblique diameter, having primarily rested in the line 
of the left oblique diameter. The head is then delivered by 
extension, rotation occurs toward the right, the anterior 



OBSTETRICS AND GYNECOLOGY. 515 

shoulder advances from the left side to the median line, and 
the shoulders and body are then delivered. 

What abnormal conditions in pregnant women are pre= 
judicial to the life of mother or child? 

Syphilis, tuberculosis, anemia, vomiting, zymotic diseases, 
placenta prsevia, pelvic deformities, renal disease, tumors, and 
degenerations of the membranes. 

Describe the method of delivery in a leg=presentation. 

This is a modified breech-presentation. The leg should be 
drawn down and the other made to engage. The labor may 
proceed as a breech delivery, or the child may be rapidly ex- 
tracted as after version. 

State the conditions compelling artificial feeding, and 
describe the proper method of modifying cow's milk for 
the newly born. 

Lack of milk-formation; refusal of the child to nurse; 
tuberculosis or other grave maternal disease ; high fever. 
Normal cow's milk should be diluted by 10 or 12 parts of 
water, some sugar of milk added, lime-water 1 or 2 drams to 
the mixture, and the whole subjected to Pasteurization before 
being administered in sterile bottles. 

Give the relations of the cephalic and pelvic diameter 
at 3 points during the birth of a L. O. A. presentation. 

At the beginning of the labor the suboccipito-bregmatic and 
bitemporal diameters of the head are concerned, the sagittal 
suture running in the right oblique pelvic diameter. After 
engagement perfect flexion causes the trachelobregmatic and 
biparietal diameters to engage. After anterior rotation the 
head rests in the conjugate pelvic diameter and the head is 
delivered by extending under the subpubic ligament. 

Diagnose pregnancy in the sixth month from phantom 
tumor. 

In phantom tumor there is general tympany over the dis- 



516 OBSTETRICS AND GYNECOLOGY. 

tended abdomen, there are no hard parts to be felt, and under 
ether the entire condition clears up. The pregnancy at six. 
months will give all the absolute signs of pregnancy, includ- 
ing movements, heart-beats, and ability to outline the fetal 
parts. 

Differentiate an ovarian cyst, a uterine fibroid, an4 
pregnancy at the fifth month. 

At the fifth month of pregnancy there will be found a 
pyramidal tumor almost reaching to the umbilicus, cystic upon 
one side and firm upon the other, alternately hardening and 
contracting. The fetal outlines may be determined indis- 
tinctly, ballottement is present, and the soft signs of preg- 
nancy may be found. 

An ovarian cyst is of slower growth, is entirely cystic to 
the feel, fluctuation will be present, the tumor will be more- 
or less to one side of the median line; none of the signs of 
pregnancy will exist; menstruation may persist. 

A uterine fibroid will be much harder, irregular in outline,, 
without the signs of pregnancy. Menstruation will be fre- 
quent and irregular, and increased in amount. 

Give the management of a pregnancy and labor compli- 
cated by a fibroid tumor of the uterus. 

If the tumor is large and the pregnancy early, abortion, 
may be induced. In later pregnancies, the tumor being situ- 
ated on the anterior uterine wall, the patient may be allowed 
to go to term and may spontaneously deliver herself. If not, 
Cesarean section is indicated. If the tumor is lodged in the- 
pelvis or is in the posterior uterine wall, elective Cesarean 
section with the Porro operation may be performed. 

Define multiple pregnancy. 

Pregnancy in which more than one fetus is present in the 
uterine cavity or in the maternal abdomen. 



OBSTETRICS AND GYNECOLOGY. 517 

Give the management of delay in the second stage of 
labor. 

If due to inertia, rest, firm abdominal binder, quinine, 
friction over the uterine fundus. If due to obstruction, as 
from rigid perineum, rigid cervix, tumor, or pelvic contrac- 
tion, correct the existing cause and deliver wth forceps or by 
some other operative procedure. 

To what diseases is the puerperal breast liable? 

Fissure of the nipple, mastitis, abscess, septic infection, 
•caking of the milk. 

Describe the vulva. Differentiate the vulva of a parous 
woman and the vulva of a non=parous woman. 

The vulva consists of the mons veneris and the two rolls of 
fatty tissue known as the labia majora. These parts are cov- 
ered with hair. In a non-parous woman the labia are in close 
contact, even when the thighs are separated; in a woman 
who has given birth to children the labia are either lightly 
in contact or the orifice is patulous and relaxed. 

Describe pelvimetry and state its obstetric uses and 
value. 

By pelvimetry is meant the measurement of the dimensions 
.and capacity of the pelvis. It is employed to determine the 
degree of pelvic contraction that may be present, and the re- 
lationship existing between the respective sizes of fetus and 
pelvis. By its use grave major obstetric operations may be 
avoided by the premature induction of labor, or the operation 
of choice may be selected and both fetal and maternal life 
saved. 

Describe the genupectoral posture and mention some of 
its important uses. 

The genupectoral or knee-chest posture is that in which 
the patient, resting upon her knees with the thighs vertical, 
inclines her body forward until she rests upon the upper 



518 OBSTETRICS AND GYNECOLOGY. 

portion of the chest with the head turned to the side and the 
arms resting above the head. This position favors gravita- 
tion of the viscera out of the pelvis, permits a replacement 
of a retro-displaced uterus, the return of a hernia through 
the ring, and the replacement of a prolapsed funis. 

Describe the causes and management of a " head=Iast " 
labor. 

This is a breech-labor, and results from a reversal of the 
shape of the fetal ellipse, the cephalic extremity of the child 
becoming the larger; it may also depend upon a deformed 
uterus or a mild degree of pelvic contraction. The treatment 
consists in efforts at version before labor, if this be deemed 
best ; inaction during the first and second stages of labor until 
the child is delivered as far as the umbilicus, and then a rapid 
delivery of the shoulders and head. 



THERAPEUTICS AND MATERIA MEDICA 



Mention the salts of lithium and describe their medic= 
inal uses. 

Benzoate, bromide, carbonate, citrate, and salicylate. 
The carbonate and citrate are used extensively in gout and 
the lithemic diathesis. The lithium salts have strong alkaline 
qualities, and act on the system as other alkalies. Lithium 
bromide is prescribed for the effects of bromide. 

What are the therapeutic uses of lobelia? 

It is used as an expectorant, diaphoretic, emetic, purgative, 
and anti-spasmodic. 

Mention the official preparations of copper. Give the 
dose of each. 

There is but one official preparation, the sulphate, which is 
given as an emetic in doses of 0.250 Gm. (4 grains), and as a 
tonic in dose of 0.010 Gm. (% grain). 

What are the therapeutic uses of oleum tiglii or Croton 
oil? 

Externally it is applied as a counter-irritant in bronchitis, 
neuritis, rheumatism, and ovaritis. Internally it is used as a 
prompt hydragogue cathartic and revulsant in acute cerebral 
congestion, apoplexy and uremia. In these cases it not only 
causes general depletion, but also a rapid efflux of blood from 
the brain. 

What are the uses of the bromides? 

The bromides are used as sedatives to the nervous system, 
to lower reflex activity, to produce sleep, to subdue excite- 

(519) 



520 THERAPEUTICS AND MATERIA MEDICA. 

ment of the genital apparatus, and to antagonize congestion 
of the brain. 

Give the indications for the use of corrosive sublimate 
internally. 

As an antisyphilitic, as a hematinic, in gastric ulcer and 
early stages of hepatic cirrhosis and in dysentery. 

What remedies are employed to correct anemic condi= 
tions and how are they used? 

Nux vomica, stimulates the blood-making organs, and is 
used as an adjunct to restorative remedies. Iron, the chief 
value of which is to improve digestion and to furnish hematin 
to the blood. The astringent preparations are the best, and 
should be given after meals. Arsenic as an adjunct to iron. 
Arsenic increases the number of blood cells, while the iron 
increases the hemoglobin contained in each. Bichloride of 
mercury, quinine and manganese increase the number of red 
blood cells. In the treatment of anemia it is of importance 
to determine the cause when possible. This will frequently 
be found to be due to gastro-intestinal irritation or constipa- 
tion. General tonic treatment, with the proper diet and 
hygienic surroundings, are often more valuable than drug 
treatment. 

Describe the therapeutic uses of the preparations of 
phosphorus. 

Phosphorus is chiefly used to promote the nutrition of 
osseous and nervous tissue. Very small doses of the drug 
have been found of excellent service in functional impotence, 
in certain skin diseases, in pernicious anemia and in neuralgia. 
Calcium phosphate and the hypophosphites are used with 
benefit in all diseases of malnutrition and where the repair 
or development of the bones is required. They are particu- 
larly useful in protracted suppuration, osteomalacia, rachitis, 
caries, chronic phthisis, and in the anemia and bone-softening 
of lactation. Sodium phosphate is a well-known purgative. 



THERAPEUTICS AND MATERIA MEDIC A. 521 

Indicate the manner in which ethylic ether (sulphuric 
ether?) should be applied to produce general anesthesia. 

As an anesthetic it may be administered from a sponge, a 
folded towel surrounded by a cone of pasteboard, or from an 
inhaler made especially for the purpose. At first the inhaler 
should be held some distance from the nose, to accustom the 
patient to the irritant effects of the ether, but soon it should 
be brought close to the nose, so that the anesthetic ma} r be 
taken in concentrated form. Insensibility of the conjunctiva 
and muscular relaxation are the indications that the patient 
is properly prepared for the operation. Many surgeons now 
employ preliminary anesthesia with nitrous oxide gas. This 
greatly shortens the first stage and allows the patient to be 
anesthetized with a comparatively small amount of ether. 

In what manner is the system affected by an overdose 
of chloral hydrate? 

The ingestion of a toxic dose produces sleep, which soon 
deepens into coma ; the pulse becomes feeble and thready, the 
respiration embarrassed, the surface cold and clammy, the 
pupils at first contracted and then dilated, and finally death 
results from cardiac and respiratory paralysis. 

— Name three general anodynes and give the dose of some 
official preparation of each. 

Opium, belladonna, cannabis indica. Morphine sulphate, 
0.015 Gm. (14 grain). Sulphate of atropine, 0.0004 Gm. 
( 1// ieo grain). Extract cannabis, 0.010 Gm. (% grain). 

State the precautions which should ordinarily be ob= 
served in administering medicines by the hypodermic 
method. 

The medicine must be in solution, and the latter should be 
neutral in reaction and freshly prepared. The skin of the 
patient should be rendered aseptic at the place selected for 
the injection. The solution is to be injected beneath the skin 
and not into it, and the blood-vessels and nerve points are to 
be especially avoided. 



522 THERAPEUTICS AND MATERIA MEDICA. 

Give the physiological effects of cinchona. 

Cinchona is an astringent bitter and a stomach tonic. At 
first it promotes appetite, digestion, the flow of saliva and 
gastric juice ; long continued it sets up a gastric catarrh, im- 
peding digestion and causing constipation. Its action is more 
astringent and irritating than that of its alkaloid, quinine. 
Its active principles are more slowly absorbed by reason of 
its bulk. In large doses quinine causes headache, ringing in 
the ears and some deafness. It is antipyretic and a heart 
depressant. On the nervous system it causes congestion of 
the brain and acts as a cerebral excitant; moderate doses 
lessen reflex activity by stimulating Setschenow's inhibitory 
center. Toxic doses permanently abolish the reflexes by de- 
pressing the spinal cord and peripheral nerves. Small doses 
exert no influence on the respiratory system, but large doses 
paralyze the respiratory center. 

Mention the conditions that contra=indicate the admin= 
istration of aconite. 

It is contra-indicated when there is adynamic action of the 
heart, cardiac degeneration or dilatation, and gastro-intestinal 
irritation or inflammation. 

Mention the alkaloids of nux vomica. 

It contains two alkaloids, strychnine and brucine. The 
latter resembles the former in its action, but is less powerful. 

For what pathologic conditions is salicylic acid admin= 
istered? What symptoms indicate the discontinuance of 
the use of salicylic acid? 

Externally it is used as an antiseptic in the dressing of 
wounds. Dissolved in collodion it is a valuable application 
for the removal of corns, The ointment is of service in 
chronic eczema. Internally, salicylic acid is of the greatest 
value in acute rheumatism. In neuralgia and neuritis of 
rheumatic origin it is of service, as it is in tonsilitis, pleurisy 
with serous effusion and in diabetes of gouty origin. It 



THERAPEUTICS AND MATERIA MEDIC A. 523 

should be discontinued if the patient suffers from headache, 
ringing in the ears, deafness, paralysis of the ocular muscles, 
great fall of temperature, excessive sweating, difficult respi- 
ration, weak pulse, convulsions, and olive-green urine. These 
are the symptoms resulting from a poisonous dose. 

For what conditions should (a) tincture of digitalis be 
given, (b) infusion of digitalis be given? Mention the 
dose of each. 

When the cardiac action of digitalis is desired the tincture 
should be employed, and no fluid should be taken within 
twenty minutes either before or after swallowing. If the 
diuretic action is required the proper preparation is the in- 
fusion. The dose of the tincture is 1 Cc. (15 minims). The 
dose of the infusion is 8 Cc. (2 fluidrachms) . 

Write a prescription illustrating chemical incompati = 
bility. 

Salicylic acid is incompatible with the salts of iron ; a pre- 
scription containing tincture of iron and salicylic acid would 
furnish an example of such incompatibility. 

Mention the principal physiologic effects of jaborandi. 
Give the alkaloids of jaborandi. 

Jaborandi is a powerful diaphoretic and sialogogue, a car- 
diac depressant, by stimulation of the vagus-ends; it is also 
myotic, emetic, and under some circumstances abortifacient. 
Jaborandi contains four alkaloids, pilocarpine, jaborine, pilo- 
carpidine, and jaboridine. 

What are the earliest signs of poisoning from the ex= 
ternal use of carbolic acid? 

Early symptoms are smoky color of the urine, lumbar pain, 
slight cerebral disturbance, after which develops impairment 
of respiration and stupor. Applied in concentrated form it 
is irritant and superficially escharotic, and produces at the 
point of application a white spot, changing to red if the 
acid is soon removed. If the application is prolonged a white 



524 THERAPEUTICS AND MATERIA ME DIG A. 

slough results from coagulation of the albumin of the tissue ; 
this is bordered by a red zone of inflammation. 

Mention the ingredients and the dose of pulvis glycyr= 
rhizae compositus. 

Compound liquorice powder contains senna 18, glycyrrhiza 
23.6, oil of fennel 0.4, washed sulphur 8, sugar 50; the dose 
is 4 Gm. (60 grains). 

For what conditions should blisters be applied? De= 
scribe the application of blisters. 

Blisters are applied for the purpose of producing counter- 
irritation. The proper manner of employing a counter-irri- 
tant to affect inflammation is not to apply it directly to an 
actually inflamed area, but a little to one side of it, at a spot 
known to be connected intimately with the diseased area by 
nerve fibers. 

By what other name is liquor potassii hydroxidi known? 
State the dose. 

Liquor potassii hydroxidi is also called solution of potas- 
sium hydroxide. Its dose is 1 Cc. (15 minims), well diluted 
with water. 

Mention the antagonist of cocaine. 

Ammonia and amyl nitrite combat the earliest symptoms 
of cardiac depression produced by cocaine. The most direct 
antagonist is chloral ; then follow chloroform, ether and mor- 
phine. 

In what conditions is gallic acid useful? 

Gallic acid and its congener, tannic acid, are astringents, 
the former being the feebler of the two. They constringe 
the muscular tissue in the walls of the minute vessels, thus 
checking secretion and hemorrhage and cutting short local 
inflammation. Gallic acid is useful in hematuria, passive 
hemorrhages, chronic cystitis, chronic diarrhea, bronchorrhea- 
and night sweats. 



THERAPEUTICS AND MATERIA MEDIC A. 525 

Describe the treatment of night sweats. 

The following drugs are found useful in the treatment of 
night sweats : Sulphate of atropine, in doses of l-75th gr. at 
bed- time; gallic acid, in 15 gr. doses; camphoric acid, in 10 
gr. doses ; and agaricine, in doses of yy to J gr. Sponge baths 
with weak solutions of alum and other astringents are some- 
times employed. 

For what purposes are diuretics employed? 

Diuretics are administered with the object of increasing 
the quantity of urine excreted : to promote the elimination of 
waste products and other poisons from the blood : to dilute 
the urine and to alter morbid conditions of the urine. 

Give the source, the common name and the principal 
therapeutic uses of oleum theobromatis. 

Oil of theobroma is commonly called cacao-butter. It is a 
fixed oil expressed from the seeds of theobroma cacao, the 
chocolate tree, which is found in Mexico, the West Indies, 
and South America. Oil of theobroma consists chiefly of 
stearin with a little olein. It has a demulcent action. Its 
chief use is as a base for making suppositories. 

What are the varieties of sinapis used in medicine? 
How are they used and for what purpose? 

There are two varieties of sinapis (mustard), sinapis alba 
and sinapis nigra. It is directed, however, that pharmaco- 
poeial preparations be made from black mustard only. Lo- 
cally used, mustard is rubefacient, counter-irritant, and a 
nerve stimulant, causing heat, redness and severe burning 
pain. Its prolonged application produces vesication by in- 
ducing local inflammation. Internally it is a local emetic in 
full doses ; in smaller doses it has a carminative action. On 
the gastric mucous membrane its irritant effect is much less 
powerful than on the skin. Mustard is commonly used as 
an application to relieve local pain and to produce counter- 
irritation. Internally it may be employed as an emetic in 



526 THERAPEUTICS AND MATERIA MEDICA. 

indigestion or narcotic poisoning. Its use as a condiment is 
general. The oil of mustard is one of the most irritant of 
the volatile oils, producing severe gastro-enteritis. 

What are the causes and treatment of urticaria? 

Urticaria is an inflammatory affection, characterized by the 
eruption of pale-red, evanescent wheals, which are associated 
with severe itching. It is due to gastro-intestinal disturb- 
ances and emotional excitement. Chronic visceral diseases 
predispose. It is produced in susceptible individuals by cer- 
tain articles of food, as well as the bites of insects, and by 
•certain drugs. Treatment : Remove the cause when possible. 
Especial attention should be paid to removing gastric irrita- 
tion and securing a free movement of the bowels with a saline 
laxative. The special remedies 1 recommended are the alkalies, 
salicylate of sodium, quinine, iodide of potassium, atropine, 
and antipyrine. Locally, lotions of water and alcohol, car- 
bolic acid, boric acid or hydrocyanic acid are very useful. 

Name three drugs belonging to each of the following 
classes: narcotics, diaphoretics, ecbolics. 

Narcotics : opium, hyoscyamus and alcohol. Diaphoretics : 
pilocarpine, aconite and cocaine. Ecbolics : ergot, oil of rue, 
and savin. 

What are the physiological effects and the therapeutic 
uses of Phytolacca? 

Phytolacca is an emeto-cathartic possessing slow but per- 
sistent action, with great nausea and considerable depression. 
It lowers the rate of respiration and of cardiac action, and is 
a motor depressant, paralyzing the spinal cord and the me- 
dulla. Death occurs from paralysis of respiration preceded 
by tetanic convulsions. The drug is said to possess alterative 
properties, and has been used internally and externally in 
chronic rheumatism and chronic skin affection. It produces 
the absorption of adipose tissue, and has been used as a 
remedy in obesity. Considering its physiologic action its em- 
ployment is not justifiable. 



THERAPEUTICS AND MATERIA MEDIC A. 527 

From what source besides nux vomica is strychnine 
obtained? What other alkaloid is obtained from the same 
source? 

Strychnine is derived from Ignatia, St. Ignatius' Bean, 
which contains the alkaloids, strychnine and brucine, abont 
1 per cent, of each. 

How do borax and boric acid differ chemically and thera= 
peutically? 

Boric acid, H 3 B0 3 , is a weak acid occurring in transparent, 
colorless, six-sided plates. It is odorless, of a slightly bitter 
taste, and is soluble in 18 parts of water, in 15.3 of alcohol 
and in 4.6 of glycerine at 25° C. Borax is the sodium borate 
Na 2 B 4 7 -j- 10H 2 ; it occurs in colorless, transparent prisms 
of cooling and sweetish taste and alkaline reaction. It is 
soluble in 20.4 parts of water at 25° C, and is insoluble in 
alcohol. Boric acid may be produced from borax by the 
action of sulphuric acid. The action of borax differs from 
that of boric acid in being a more powerful antiseptic and 
disinfectant, as well as being far more irritating when locally 
applied. 

Name the official preparations of gold and describe its 
therapeutic uses. 

Gold, aurum, has but one official salt, the gold and sodium 
chloride, but triturations of the metal itself may be prepared 
according to the general pharmacopoeial formulae for such 
preparations. Gold has been recommended in certain forms 
of gastric disturbance, in chronic Bright 's disease, in certain 
nervous disorders, in impotence, and in pertussis. It is not 
generally employed. 

What is the adult dose of (a) sulphate of atropine, (b) 
tincture of cantharides, (c) tincture of colchicum? 

(a) 0.0004 Gm. (V 160 grain). (b) 0.3 Oc. (5 minims). 
(c) 2 Cc. (30 minims). 



528 THERAPEUTICS AND MATERIA MEDICA. 

Mention three alkaloids which are chemically alike and 
almost identical in physiologic effect. 

Cinchoninse Sulphas, Cinchonidinse Sulphas and Quinidinse 
Sulphas. 

State the cause and give the treatment of trichinosis. 

Trichinosis is a typhoid condition resulting from the en- 
trance of a parasite, the trichina spiralis, into the intestinal 
canal and the subsequent migration of these parasites into 
the muscular structure. The trichina are introduced into the 
human body by eating infected hog's flesh, either raw or im- 
perfectly cooked. The preventive treatment consists in eating 
no pork that has not been perfectly cooked. If the parasites 
have been recently taken, emetics and purgatives are indi- 
cated. After migration has begun the powers of life should 
be sustained by nourishing food, stimulants and tonics. 

What drug is antagonistic to pilocarpine? 

Atropine in dose of 1-100 gr. for each }i gr. of pilocarpine. 
Where is the habitat of belladonna? 

It is indigenous in the mountainous districts of central 
and southern Europe and Asia, and is cultivated in Europe 
and in the United States. 

What are the sources of sulphur? 

Sulphur is obtained native in several volcanic districts or 
from the native sulphides of iron and copper by roasting, as 
it sublimes at about 238° F. 

In what dose may the oil of wintergreen be adminis= 
tered to an adult for rheumatism? 

Average dose, 1 Cc. (15 minims). 

How is nitrite of amyl administered and for what pur- 
pose? 

Nitrite of amyl is indicated for the same general conditions 
as nitro-glycerin. It is generally prescribed in glass pearls, 
containing 3-5 minims, and these are broken in a handker- 



THERAPEUTICS AND MATERIA MEDICA. 529 

chief and inhaled. It is a valuable heart stimulant, checks 
spasms and dilates peripheral vessels. It is especially em- 
ployed for the relief of attacks of angina pectoris. 

Describe the therapeutic uses of sparteine and state the 
dose of the sulphate for hypodermic uses. 

Sparteine is the alkaloid of Scoparius, Broom, and is a 
valuable diuretic and heart stimulant. Its dose hypoder- 
mically is 0.010 Gm. (y 5 grain). 

What are the physiologic effects and the thereapeutic 
uses of the balsam of Peru? 

Balsam of Peru is employed locally as a sedative and para- 
siticide. Internally it is of value as an expectorant in chronic 
bronchitis. This balsam is antiseptic, disinfectant, stimulant 
to the circulation and sedative to the nervous system, acting 
chiefly on the mucous membrane ; it is a tonic and expec- 
torant, diuretic and diaphoretic. 

Give the common name, therapeutic uses and dose of 
sodium sulphate. 

Glauber's salt; it is a powerful purgative; average dose, 
16 Gm. (240 grains). 

Describe the therapeutic uses of sodium chloride. 

A bath may be made more stimulating for debilitated 
patients by the addition of a few ounces of salt to the water. 
An enema containing one or two tablespoonfuls of salt to the 
pint of water is sometimes used effectively against thread- 
worms. The subcutaneous or intravenous injection of a 
three-tenth per cent, solution of sodium chloride has proven 
of marked benefit in cholera, uremia and acute anemia from 
hemorrhages. 

State the composition and therapeutic uses of pulvis 
jalapae compositus. 

Compound powder of jalap -contains of jalap 35 parts, of 
potassium bitartrate 65 parts, rubbed together until thor- 
34 



530 THERAPEUTICS AND MATERIA MEDICA. 

oughly mixed. It is much employed to produce free watery 
evacuations in ascites and anasarca. Since it is nearly taste r 
less, it is a useful cathartic for children. 

~ What is a physiologic action of camphor in medicinal 
doses on (a) the skin, (b) the circulation? 

(a) Bubefacient; (b) increases the pulse-rate and raises 
arterial tension. 

Describe the forms of poisoning by ergot. 

There are two forms, the acute ergotism and chronic ergot- 
ism. The symptoms of the acute form are nausea, vomiting, 
colic, difficult micturition, and purging. The drug slows the 
heart, raises arterial tension, dilates the pupil, and produces 
vertigo. It stimulates the contraction of unstriped muscle 
fiber, especially affecting the sphincters and uterus. In very 
large dose it produces cerebral and spinal anemia and violent 
convulsions. There are two varieties of the chronic ergot 
poisoning, the convulsive and the gangrenous. The convul- 
sions are tetanoid spasms of the flexor muscles, the uterus, the 
intestinal fibers and muscles of respiration, ending in coma 
and death by asphyxia. The gangrenous form begins with 
coldness and numbness of the limbs, formication of the skin, 
loss of sensibility and abolishment of the special senses, bullae 
of blood and ichor, followed by dry or moist gangrene of the 
lower extremities, buttocks and other parts, epileptiform con- 
vulsions, coma and death. 

In what pathologic condition is veratrum viride useful? 

Locally, veratrum is of value in neuralgia. Internally the 
drug is advised by some in the early stages of sthenic pneu- 
monia and in puerperal eclampsia. 

Mention the therapeutic uses of phenacetine. 

It is antipyretic, analgesic, and hypnotic. It is useful in 
whooping-cough and in rheumatic and other fevers. 



THERAPEUTICS AND MATERIA MEDIC A. 531 

Give the name of the alkaloid of Calabar and state its 
dose. 

Physostigmine (or eserine). The dose of the sulphate is 
0.001 Gm. (V 64 g T ain) . 

Mention three vegetable emmenagogues and state the 
dose of each. 

Ergot, the dose of the fluid extract is 2 Cc. (30 minims) ; 
savin, the dose of the fluid extract is 0.3 Cc. (5 minims) ; 
tansy, the dose of the oil is 1 to 3 drops. 

Define therapeutic incompatibility, chemical incompati= 
bility. 

Therapeutic incompatibility arises when two agents are 
administered together which oppose each other in their physi- 
ologic actions. Chemical incompatibility is due to the union 
of two or more substances in combination whereby chemical 
change results. 

Write a prescription containing dilute hydrochloric acid, 
syrup of wild cherry and camphor water for a cough. 
Write on this prescription the dose for an adult. 

Jan. 1, 1903. . Mr. John Smith. 

R . Acidi hydrochloric! dil f 3 v 

Aquae camphorse f % i 

Syr. Pruni virginianae q. s. ad f 25 iv 

M. Sig. — Teaspoonful every four hours. 

Wm. Jones, M. D. 

State the dose of (a) fluid extract of belladonna, (b) 
extract of conium. 

(a) 0.05 Cc. (1 minim), (b) 0.2 Cc. (3 minims). 
In what pathologic conditions is uva ursae used? 

Uva urssB is employed as an antiseptic and stimulating diu- 
retic in chronic inflammatory affections of the genito-urinary 
tract, such as pyelitis, cystitis, and urethritis. 



532 THERAPEUTICS AND MATERIA MEDIC A. 

State the name and the dose of each of five official 
preparations of opium. 

Opii pulvis, 0.065 Gm. (1 grain) ; extract of opium, 0.030 
Gm. (i/ 2 grain) ; tincture of opium, 0.5 Cc. (8 minims) ; cam- 
phorated tincture of opium (paregoric), 8 Cc. (2 fluid- 
drachms) ; wine of opium, 0.5 Cc. (8 minims). 

In what diseases are preparations of arsenic useful? 

Locally, arsenic is useful in lupus and epithelioma. It is 
a valuable alterative in diabetes, chronic rheumatism, phthisis 
and asthma. In malaria it ranks next to quinine; in the 
simple chorea of childhood it is almost a specific. It is of 
great value in anemic conditions. 

State the name and dose of a drug belonging to each of 
the following classes: (a) emetics, (b) diuretics, (c) dia- 
phoretics, (d) cathartics. 

(a) Ipecac, the emetic dose of the fluid extract is 1 Cc. 
(15 minims) ; (b) digitalis, the dose of the infusion is 8 Cc. 
(2 fluidrachms) ; (c) pilocarpus, dose of fluid extract is 2 
Cc. (30 minims) ; (d) jalap, the dose of the compound jalap 
powder is 2 Gm. (30 grains). 

State the name and the alterative dose of a preparation 
of mercury capable of producing acute poisoning. Men= 
tion the chemical antidote for this preparation. 

Bichloride of mercury; dose, 0.003 Gm. (V 20 grain). In 
cases of poisoning by corrosive sublimate the stomach should 
be evacuated, the body temperature maintained, and egg 
albumin given in large quantities as an antidote. 

How should asthma of cardiac origin be treated? 

The term cardiac asthma is applied to any shortness of 
breath which is the result of deranged cardiac action. The 
treatment is, of course, the treatment of the diseases which 
are responsible for it. Rest in bed is most important. The 
cardiac condition may indicate the need of digitalis if, for 
instance, mitral regurgitation exists with loss of compensa- 



THERAPEUTICS AND MATERIA MEDIC A. 533 

tion ; strychnine should be given if the heart muscle is weak ; 
nitro-glycerine may be given in the early stages of arterial 
sclerosis. The particular treatment will depend upon the 
condition of the circulation. 

Outline the treatment of uremia. 

The name uremia is applied to a group of symptoms result- 
ing from the retention of toxic materials in the blood which 
should have been eliminated by the kidneys. Sweating should 
be encouraged by the use of hot-air or vapor baths. Cath- 
arsis should be induced by croton oil in one-drop doses or 
by elaterium in y 8 grain doses. The renal engorgement may 
be relieved by a dry or wet cup to the loins. Venesection is 
indicated if the patient is robust and the pulse is strong. If 
the pulse is weak, heart stimulants should be administered. 
If convulsions occur, 30 to 40-grain doses of chloral may be 
given by the rectum, or nitrite of amyl inhaled. 

Describe the treatment of apoplexy due to cerebral 
hemorrhage. 

During the attack the head and shoulders should be slightly 
elevated and an ice-bag applied to the head. Prompt cath- 
arsis should be produced by croton oil, in a little glycerin, 
placed on the back of the tongue. If the pulse be strong, 
bleeding is indicated; if the pulse is feeble, hypodermic 
injection of such stimulants as strychnine should be em- 
ployed. Bed sores must be prevented by frequently chang- 
ing the patient's position and sponging with alcohol the 
parts exposed to pressure. During convalescence those pre- 
disposed to such attacks should lead a quiet life and avoid 
excitement. Iodide of potash should be administered over a 
long period. After the primary rigidity has appeared in the 
affected muscles galvanism and massage may assist in restor- 
ing lost functions. 

State the official name and the minimum poisoning dose 



534 THERAPEUTICS AND MATERIA MEDICA. 

of (a) strychnine sulphate, (b) morphine sulphate, (c) 
chloral. State the antidote for each. 

(a) Strychninge sulphas. The fatal dose of strychnine 
sulphate is placed by Taylor at \ to 2 grains for an adult, 
but recovery has taken place after much larger doses. The 
antidotes are chloral hydrate, tannic acid and animal char- 
coal, (b) Morphinse sulphas. Toxic dose depends on per- 
sonal susceptibility ; \ grain of morphine sulphate has killed 
an adult. Potassium permanganate is the best antidote if 
the morphine is in the stomach ; black coffee and atropine are 
of value, (c) Chloral hydrate has caused death in several in- 
stances by a 30-grain dose. Atropine is its antidote. 

Write a prescription containing the tincture of the chlor- 
ide of iron and the chlorate of potash, with the proper dose 
for a child four years old. 

Jan. 1. 1903. John Smith. 

R . Potassii chloratis gr. xvi. 

Tincturse ferri chloridi f 3 iss 

Ext. glycerrhizse 3 i 

Aquae, q. s. ad f ^ iv 

Sig. — A teaspoonful in water every three hours. 

John Jones, M. D. 

Criticize the following prescription: 

Tr. guaiac f^i 

Aq. cinnamon f £ ii 

Sig. — A teaspoonful every four hours. 

5, 12, '99. Dk. J. 

This is an example of pharmaceutical incompatibility. An 
alcoholic tincture should not be prescribed with aqueous solu- 
tions, nor should resinous tinctures be combined with aqueous- 
solutions. 

What is the source of carbo ligni? What are the thera- 
peutic uses of carbo ligni? 

Carbo ligni is charcoal derived from soft wood. It is em- 
ployed as an absorbent of foul gases and as a deodorant and 



THERAPEUTICS AND MATERIA MEDIC A. 535 

disinfectant. Internally it is useful in affections of the 
gastro-intestinal tract associated with hyperacidity and flat- 
ulent distension. 

- Give the dose of (a) caffeine, (b) wine of ipecac. 

(a) 0.065 Gm. (1 grain) ; (b) 1 Cc. (15 minims). 
What are the therapeutic uses of convallaria majalis? 

Lily-of- the- valley possesses actions analogous to digitalis, 
strengthening the heart and increasing the flow of urine; it 
does not disturb the stomach and is not cumulative in its 
effects. 

Define a general anesthetic. Mention three general 
anesthetics in common use. 

A general anesthetic is a drug which when inhaled suffi- 
ciently produces complete unconsciousness and loss of sen- 
sation, also lessened motor power. The general anesthetics 
mostly belong to the alcohols and ethers. Ether, chloroform 
and nitrous oxide are three examples of such drugs. 

Mention three principal salts of potassium used in medi= 
cine and give the dose of each. 

Potassium bromide, dose 1 Gm. (15 grains) ; potassium 
acetate, dose 2 Gm. (30 grains) ; potassium bicarbonate, dose 
2 Gm. (30 grains). 

Of what is duboisine an alkaloid? What are the physio= 
logic effects of duboisine? 

Duboisine is the alkaloid of duboisia; it is believed to be 
identical with hyoscyamine, and strongly resembles atropine. 
It is a prompt mydriatic. In moderate doses it induces quiet 
and refreshing sleep, and is not dangerous. When given in 
large doses it may produce vertigo, nausea or syncope. It is 
less irritating to mucous membranes than atropine. 

What are the therapeutic uses of nitro=glycerin? By 
what other names is nitro=glycerin known? 

Nitro-glycerin is also known as glonoin and trinitrin. It 



536 THERAPEUTICS AND MATERIA MEDIC A. 

is valuable in certain forms of cardiac disease, especially in 
sudden heart failure, angina pectoris and fatty degeneration 
of the heart. It relieves the high arterial tension and the 
dyspnea of chronic nephritis. 

Define materia medica, therapeutics. 

Materia medica treats of the substances used as medicines 
and describes their origin, composition, chemical properties, 
modes of preparation and administration, also their physio- 
logic and toxicologic actions. Therapeutics comprises all the 
science and art of healing, including the use of medicines and 
all other agents given with the object of curing disease. 

What are the therapeutic uses of sulphur? 

Externally it is of value as a stimulant and parasiticide in 
diseases of the skin of chronic type. Internally it is a mild 
laxative. It is of use both internally and externally in 
chronic articular rheumatism. 

Outline the general treatment of acute articular rheu= 
matism. Write a prescription containing at least two 
ingredients for an adult to relieve pain in acute articular 
rheumatism. 

Rest in bed is essential. The joints should be wrapped in 
cotton-wool. The nourishment should consist of milk, beef 
tea, broths and gruel. The free use of lemonade or mineral 
waters is advisable. The best remedies are the salicylates 
and the alkaline salts of potassium. The following is a use- 
ful combination : 

R . Sodii salicylat 5 ii 

Potass, citrat % iii 

Glycerini. 

Tinct. cardamom, comp ; aa f % ss 

Aquae, q. s. ad f 3 v. M. 

Sig. — A tablespoonful every two hours. 

What are the therapeutic uses of strophanthus? Men= 
lion the dose of the tincture of strophanthus. 

Strophanthus is a valuable cardiac tonic, and may be em- 



THERAPEUTICS AND MATERIA ME DIG A. 537 

ployed in the class of cases in which digitalis is indicated. 
The dose of the tincture is 0.5 Cc. (8 minims). 

Define official preparations as applied to preparations of 
medicinal agents. 

All of those drugs which have gained entrance to the Phar- 
macopoeia are termed official preparations. 

What are the therapeutic uses of cardamom? 

It is used as an agreeable aromatic for disguising the taste 
of other drugs and as a carminative. 

Describe gelsemium. State the dose of the preparations 
of gelsemium. 

Yellow jasmine is the rhizome and roots of gelsemium sem- 
pervirens, a climbing plant of the natural order Loganicese, 
with showy yellow flowers. It grows in the forests of the 
southern United States. It contains a volatile oil, a resin 
and an alkaloid, gelsemine, in combination with gelsemic acid. 
Preparations are the fluid extract, dose 0.05 Cc. (1 minim) ; 
the tincture, dose 0.5 Cc. (8 minims). Gelsemium itself is 
given in dose of 0.065 Gm. (1 grain). 

Mention the therapeutic uses of iodine. 

Iodine is a useful counter-irritant. Internally it is used 
chiefly for its alterative effect. In the form of Lugol's solu- 
tion (2 or 3 drops) it will sometimes control obstinate vom- 
iting. 

State the physiologic effects of physostigma on the res= 
piration, the heart and the pupil of the eye. 

Small doses do not affect the circulation or respiration, but 
toxic doses kill by paralyzing the respiratory center. The 
arterial pressure is raised by the drug stimulating the heart 
or its contained ganglia, and probably also by stimulating the 
vasomotor center. Toxic doses paralyze the heart. Physo- 
stigmine powerfully contracts the pupil. This results from 
stimulation of the peripheral fibers of the oculo-motor nerve 



538 THERAPEUTICS AND MATERIA MEDICA. 

and from paralysis of the peripheral filaments of the sympa- 
thetic nerve. 

Describe the physiologic action of phosphorus. 

In small doses phosphorus stimulates the brain and circu- 
lation, the functions of the stomach and the genital organs 
ana the growth of bones. It aids digestion by irritating the 
end organs of the gastric nerve, but produces eructations of 
hydrogen phosphide. 

Outline the therapeutic uses of atropine. 

Atropine is used in poisoning by opium, physostigma and 
hydrocyanic acid. In ptyalism from mercury, pregnancy, 
etc., in the sweats of phthisis, in sudden cardiac failure, and 
as a mydriatic. It is very useful in lead-poisoning, combined 
with potassium iodide. It is useful as hemostatic in profuse 
metrorrhagia after abortion, in metrorrhagia of obscure: 
origin, and in the hemoptysis of phthisis. 

Define sialagogue. Give an example of (a) topical siala= 
gogue, (b) general sialagogue. 

Sialagogues are agents which increase the secretion and 
flow of saliva and buccal mucus. Topical sialagogues act by 
reflex stimulation, as tobacco and mustard. General siala- 
gogues act through their influence on the glands or their 
secretory nerves, as pilocarpine and the mercurials. 

For what pathologic conditions is camphor used? 

Camphor may be employed in diarrhea, cholera, vomiting, 
cardiac depression, nervousness and nervous headache, the in- 
fectious fevers, dysmenorrhea, after-pains, and catarrhal con- 
ditions. Locally it is of use wherever counter-irritation or a 
local anodyne is required. 

Give the official name and the composition of (a) Fow= 
ler's solution, (b) Donovan's solution. 

Solution of potassium arsenite is a 1 per cent, solution pre- 
pared by boiling together arsenous acid 1, potassium bicar- 
bonate 2, compound tincture of lavender 3, and distilled 



THERAPEUTICS AND MATERIA MEDIC A. 539 

water to 100 parts. The solution of arsenous and mercuric 
iodides (Donovan's solution) contains arsenous iodide and 
mercuric iodide, of each 1 part in 100 of distilled water. 

State the dose of (a) spirit of nitro=glycerin, (b) wine 
of colchicum (sem.), (c) extract of colocynth. 

(a) 0.05 Cc. (1 minim) ; (b) 2 Cc. (30 minims) ; (c) 0.030 
Gm. (i/ 2 grain). 

Describe the therapeutic applications of sulphate of 
copper. 

It is a prompt and efficient emetic, and is so used in croup 
and narcotic poisoning. In phosphorus poisoning it forms a 
comparatively insoluble phosphide of copper, besides produc- 
ing emesis. It is of value in acute diarrhea and chronic 
dysentery combined with opium. Locally it is employed in 
throat affections, gonorrhea, granular lids, corneal ulcers,. 
and chronic inflammation of mucous membranes. 

Mention (a) a hydrogogue, (b) a cholagogue. State the 
dose of each. 

(a) Elaterium, the active principle, elaterin, is given in 
doses of 0.005 Gm. (V 10 grain) ; (b) podophyllum, dose 0.500 
Gm. (iy 2 grains). 

Mention four remedies used to control vomiting and 
state the dose of each. 

Cerium oxalate, 0.065 Gm. (1 grain) ; subnitrate of bis- 
muth, 0.500 Gm. (7% grains) ; cocaine hydrochloride, 0.030 
Gm. (y 2 grain) ; acid carbolic, 0.065 Gm. (1 grain). 

- Write a compound prescription for an adult suffering 
from insomnia. 

Jan. 1, 1903. Mr. John Smith. 

R . Potassii bromidi g iv 

Chloralis hydratis g in 

Tincturse assafoetidae f 3 iv 

Syrupi f 3 vi 

Aquae, q. s. ad f % vi 

M. Sig. — Tablespoon ful every two hours until sleep is induced. 

Jos. Jones, M. D. 



540 THERAPEUTICS AND MATERIA MEDIC A. 

What are the uses of apomorphine? 

In narcotic poisoning, such as from opium or alcohol, apo- 
morphine is a valuable emetic. When the circulation is weak 
it must be given cautiously. It is of service as an expectorant 
in the dry stage of acute bronchitis and in chronic bronchitis 
when the expectoration is viscid and scanty. The emetic dose 
of apomorphine hydrochloride is 0.005 Gm. (V 10 grain) in 
alcohol. As an expectorant by the mouth the dose is 0.002 
Gm. (V 30 grain). 

State the effect of amyl nitrite on the vascular system. 

The inhalation of nitrite of amyl is speedily followed by 
flushing of the face, fulness in the head, quickening of the 
pulse and a fall of the blood-pressure. The flushing is due 
to dilatation of the arterioles, brought about partly by de- 
pression of the vasomotor centers and partly by direct action 
on the blood-vessel walls. The quickening of the pulse re- 
sults from a depression of the cardiac inhibitory centers in 
the medulla. The fall of blood-pressure is mainly due to dila- 
tation of the vessels. Upon the heart the drug acts primarily 
as a stimulant, but in large amounts it soon acts as a cardiac 
depressant. 

Describe asafetida and outline its physiologic effects. 

Asafetida is a gum-resin obtained by incision from the 
living root of ferula fetida, a perennial herb of the natural 
order Umbelliferse, native of Persia and Afghanistan. Its 
principal constituent is a sulphuretted volatile oil; it also 
'contains a gum and a resin. It is a powerful anti-spasmodic, 
a stimulant to the brain and nervous system, a stimulant ex- 
pectorant; also tonic, laxative, diuretic, diaphoretic, emmena- 
gogue, aphrodisiac and anthelmintic in action. 

State the effect of the bromides on the respiration and 
on the action of the heart. What effect is the long con= 
tinued use of the bromides liable to produce on the mental 
faculties? 

The bromides reduce the number of the respirations, and 



THERAPEUTICS AND MATERIA MEDIC A. 541 

the heart's action and force, and lower the arterial tension. 
The continued use lessens the activity of the brain-cells, pro- 
ducing weakness of mind and somnolence. 

In what diseases is conium used? 

It is especially indicated in diseases characterized by exces- 
sive motor activity. It is useful in chorea, paralysis agitans, 
in acute mania, and delirium tremens; it is also employed in 
tetanus, asthma, whooping-cough, and other spasmodic affec- 
tions. 

Define diaphoresis. Mention three diaphoretics and 
state the dose of each. 

Diaphoresis is a condition of sweating. Aconite, veratrum 
viride, and the salicylate of sodium. The dose of aconitine is 
0.00015 Gm. (V 400 grain). The tincture of veratrum, 1 Cc. 
(15 minims). Salicylate of sodium, 1 Gm. (15 grains). 

Mention ten drugs, the use of any one of which may 
cause skin eruption. 

Aconite, antimony, antipyrine, atropine, quinine, tar, tur- 
pentine, salicylic acid, mercury, opium. 

Write a prescription containing a stomachic to be used 
in alcoholism. 

R . Tinct. Nucis Vomicae f 3 ii 

Tinct. Gentianse Co f ^ iv 

M. Sig. — Teaspoonful before meals. 

What is the alkaloid of hyoscyamus? What is the dose 
of hyoscine hydrobromide for hypodermic use? 

It contains an alkaloid, hyoscyamine. The dose of hyos- 
cine hydrobromide for hypodermic use is 0.0005 Gm. (V 12S 
grain) . 

In what form is iodine most frequently administered in= 
ternally? What is the antidote for free iodine? 

Potassium iodide. Starch is the antidote to free iodine, but 



542 THERAPEUTICS AND MATERIA MEDIC A. 

the stomach must be immediately evacuated, as the iodide of 
starch is not inactive. 

Mention three commonly used myotics. 

Eserine is the only myotic generally employed in ophthal- 
mic practice. Opium and pilocarpine are two other drugs 
possessing myotic effects. 

State the effects of alcohol and strychnine on the arte= 
rioles. 

Alcohol causes a dilatation of the .arterioles, while strych- 
nine contracts the arterioles, except in very large doses, when 
it produces relaxation of the smaller vessels. 

Describe the symptoms and give the treatment of gastro= 
duodenitis. 

The symptoms of gastro-duodenitis partake of gastritis 
with an enteritis added, fever, gastric pain and vomiting, in 
addition to which there may be colic and diarrhea. Simple 
catarrhal jaundice will result from an extension of a gastro- 
duodenitis into the common duct. The general symptoms of 
this condition are jaundice, loss of appetite, nausea, vomiting, 
a sense of fulness and constipation or irregular action of the 
bowels; there may also be slight fever. The treatment 'Con- 
sists in saline aperients, which reduce the catarrhal inflam- 
mation ; and second, the use of such foods as do not require 
the bile to facilitate digestion. Skimmed milk, animal broths 
and egg albumen and copious drinking of water are advised. 

Mention the chief alkaloids and the therapeutic class of 
belladonna and of Calabar bean. 

Belladonna contains two alkaloids, the official atropine 
and hyoscyamine. Belladonna is a delirifacient, Calabar 
bean contains physostigmine (eserine). It is a depresso- 
motor. 



THERAPEUTICS AND MATERIA MEDIC A. 543 

Mention a soluble salt of lead. To what therapeutic 
class does bismuth subnitrate belong? 

Lead acetate. Bismuth, subnitrate is classed with astrin- 
gents. 

What is the physiologic action of Indian hemp? 

Cannabis indica, Indian hemp, produces in full doses a con- 
dition of mental exhilaration associated with hallucinations 
and disordered consciousness of time, locality and personality. 
This stage of excitement finally gives way to sleep, which may 
last for several hours. Sensation is perverted and benumbed, 
and before sleep is induced there is often more or less general 
anesthesia. The drug has little influence upon circulation 
and respiration. 

What is the physiologic action of veratrum viride on the 
circulation? 

It lessens greatly the force and rate of cardiac pulsation 
and reduces arterial tension by depression of the vasomotor 
center and of the heart itself. 

Give the physiologic action of senna and state what part 
of it is used in medicine. Where does senna grow most 
abundantly? 

The leaflets of Cassia acutifolia and of Cassia angustifolia; 
the former grows in Egypt, and the latter in southern India. 
Senna is a brisk cathartic, producing in three or four hours 
after its ingestion copious watery stools. It acts by increas- 
ing both peristalsis and the intestinal secretion. It is ab- 
sorbed by the circulation. 

Describe bromism and state how it is produced. 

Bromism is produced by the continuous administration of 
bromides. The condition is characterized by anemia, fetor 
of the breath, gastric disturbance, diminution of the reflexes, 
unsteady gait, impairment of tactile sensibility, abolition of 
sexual function, mental depression, failure of memory, som- 
nolence, and a general eruption of acne. 



544 THERAPEUTICS AND MATERIA MEDICA. 

What are the therapeutic uses of sodium salicylate? 

It is of value as an antipyretic, as an anti-rheumatic and 
anti-neuralgic. It is of the greatest service in pleurisy with 
serous effusion, and is often useful in diabetes. "When given 
early it will often abort tonsilitis. It is of service as a 
gastro-intestinal disinfectant. 

Give the dose of pilocarpine. 

The dose of pilocarpine hydrochloride is 0.01 Gm. (% 
grain). 

Describe the therapeutic uses of hydrochloric acid. 

It is employed internally in the treatment of dyspepsia 
associated with subacidity. It is useful as a refrigerant and 
digestant in the continued fevers. In conjunction with 
strychnia it is of value in intestinal indigestion. The strong 
acid is also an escharotic. 

What are the principal uses of calcium chloride? To 
which ingredient does it owe its energy? 

Calcium chloride is of value as an internal remedy in the 
various manifestations of the strumous diathesis and to arrest 
bleeding. It often causes the resolution of glandular enlarge- 
ment, and is of value in chorea, lupus and eczema. It owes 
its energy to the calcium contained. 

What are the symptoms of opium poisoning? 

Unless the dose has been very large there is at first a stage 
of excitement, in which the imagination is stimulated and 
the feelings exalted. This stage is soon followed by depres- 
sion ; the patient becomes stupid and drowsy, and finally falls 
asleep. The sleep deepens into coma, the pulse becomes slow 
and full, the pupils contracted, the respiration slow and heavy 
and the face suffused. At this time it is still possible to 
arouse the patient by a loud noise, flagellation or shaking. 
In the third stage the coma becomes absolute, the pulse rapid 
and feeble, the breathing shallow and irregular, the skin 



THERAPEUTICS AND MATERIA MEDIC A. 545 

moist, the muscles relaxed, the pupils dilated, and finally 
death results from paralysis of the respiration. 

Mention the remedy which will arrest the secretion of 
milk and state how it should be employed. 

Camphor used locally by inunction in saturated solution of 
olive oil is efficient in checking the secretion of milk, as is 
■belladonna. 

Give the methods and the therapy of cold water treat= 
ment applied externally. 

Cold water may be applied in the form of cloths saturated 
with it, by sponging, bathing or packing with ice. The cold 
bath is the most frequently employed. A bath-tub half full 
of water at 70° F. is kept in readiness at the bedside of the 
patient, and whenever the temperature rises above 102.4° F. 
the patient is wrapped in a sheet and carefully lifted into the 
tub. While in the bath cold affusions should be applied to the 
head, and the body should be constantly subjected to gentle 
friction and massage, so as to bring new relays of blood to 
the surface. A stimulant is often necessary to counteract the 
shock. After remaining in the water 15 to 20 minutes he is 
placed in a dry sheet and covered with a light blanket. 

What are the therapeutic uses of alchohol? 

The question of the advisability of employing alcohol in 
medicine has given rise to never-ending controversy. Many 
give it a high place, while others do not employ it at all. The 
external and local use of alcohol includes many applications 
of its antiseptic, refrigerant and rubefacient qualities. In 
the form of champagne it is especially valuable in controlling 
vomiting. A single dose of whisky or brandy is an efficient 
combatant of fainting or of collapse. In fevers it acts as an 
antipyretic, a food, and promotes sleep. It is well to with- 
hold it until the first sound of the heart becomes feeble and 
dull, and then to use it boldly. It is of especial value in the 
treatment of pneumonia, typhoid fever and snake-bite. 
35 



546 THERAPEUTICS AND MATERIA MEDIC A. 

Mention the physiologic effects of bryonia. What is the 
dose of the tincture of bryonia? 

Bryonia is a pure irritant, setting up local inflammation 
wherever it is applied. It has a vesicant action on the skin, 
and is violently irritant to the serous and mucous membranes. 
It produces cerebral congestion, with frontal headache and 
vertigo. It is a drastic purgative and a powerful diuretic. 
It causes in full dose hepatic and renal congestion, vesical 
tenesmus, and depression of the heart's action. The dose of 
the tincture is 5 drops to % ounce. 

State the dose of aconitine. 

0.00015 Gm. (V 400 grain). 

Give the composition and state the uses of lotio hydrar= 
gyri flava. 

Yellow wash is a favorite application for syphilitic sores. 
It is prepared by adding 18 grains of corrosive sublimate to 
10 ounces of lime-water, producing the yellow oxide. 

Give indications for the internal use of bichloride of 
mercury. State the dose of bichloride of mercury for in= 
ternal use. 

It is of value in anemia, as an absorbent in diphtheria, as 
a general alterative, and is highly prized as an anti-syphilitic 
remedy in the secondary and tertiary stages. The dose is 
0.003 Gm. (V 20 grain). 

What are the principal therapeutic uses of the salt of 
lead? 

Lead salts are chiefly used as astringents and hemostatics. 
The acetate is an efficient internal styptic. The nitrate is of 
value locally in epithelioma and unhealthy granulations. The 
iodide is employed locally to enlarged lymphatic glands and 
in -chronic skin affections. The carbonate is only used exter- 
nally to protect irritated surfaces, such as intertrigo, etc. 



THERAPEUTICS AND MATERIA MEDIC A. 547 

Explain the constipating action of opium. 

Opium arrests all the secretions except the milk and the 
sweat, and retards the digestive juices. The biliary and 
glycogenic functions of the liver are affected and metabolism 
greatly reduced. Its constipating action is produced chiefly 
loy stimulation of the inhibitory nerves of the intestines 
through the splanchnics. 

Mention the symptoms of poisoning by phosphorus. 

Toxic doses of phosphorus produce, after the lapse of a few 
hours, a garlicky taste in the mouth, thirst, intense abdominal 
pain, obstinate vomiting, restlessness and prostration. The 
ejected materials contain mucus, bile, and occasionally dis- 
integrated blood, and are luminous in the dark. At the end 
of 24 or 36 hours the symptoms gradually subside and the 
patient feels comparatively comfortable, but soon jaundice 
develops, the vomiting and pain return, the liver becomes 
enlarged and painful, the urine contains albumin, bile, hypo- 
phosphoric acid and crystals of leucin and tyrosin. The 
tongue is coated, the breath offensive, the belly distended, the 
bowels either constipated or loose, and the stools clay-colored. 
Death is generally preceded by grave nervous symptoms, such 
as headache, delirium, convulsions, stupor and coma. AVhen 
recovery follows, convalescence is protracted. 

Write a prescription containing a sedative and an ex= 
pectorant for a bronchial cough in a three=year=old child. 

Jan. 1, 1903. For Walter Smith. 

H • Tinctura opii camphoratae gtt. lxiv 

Potassii citratis % ii 

Syrupi pruni virginianse, q. s. ad f 3 iv. 

M. Sig. — Teaspoonful every four hours. 

Wm. Jones, M. T). 

In what pathologic condition is jaborandi useful? 

It is of use in dropsy, especially of renal origin, in uremia, 
Inflammation of the serous membranes, in diabetes insipidus, 



548 THERAPEUTICS AND MATERIA MEDIC A. 

but is contra-indicated when the heart's action is weak. It 
is useful in the form of a lotion for alopecia. 

What is the dose of carbolic acid for internal adminis= 
tration? 

Dose 0.065 Gm. (1 grain), well diluted. 

What is the common name of lactucarium? State the 
physiologic action of lactucarium. 

Lettuce. Lactucarium is feebly hynotic and somewhat 
sedative and diuretic. The syrup is a good vehicle for ex- 
pectorants and anti-spasmodics. 

What is the physiologic action of colchicum? 

Emetic, diuretic, diaphoretic, a drastic purgative and car- 
diac depressant, gastro-intestinal irritant. In small doses it 
is an emeto-cathartie. 

What serious results may ensue from indiscriminate use 
of acetanilide? 

A toxic dose destroys the oxygen-carrying function of the 
blood and forms methyl-hemoglobin, causes fatty degenera- 
tion of the heart, liver and kidneys in animals poisoned by it. 
When administered continuously or in too great dose it is apt 
to cause subnormal temperature, cyanosis and collapse. 

— What is cascara sagrada? State the dose of the fluid 
extract of cascara sagrada. 

It is the bark of Rhamnus purshiana, California buckthorn. 
The dose of the fluid extract is 1 Cc. (15 minims). 

What are the therapeutic uses of tincture of capsicum 
internally administered? State the dose of the tincture 
of capsicum. 

It is employed chiefly as a stomachic and carminative. A 
weak solution of the tincture is also a much used gargle in 
sore throat with relaxed uvula. The drug is especially valu- 



THERAPEUTICS AND MATERIA MEDIC A. 549 

able in alcoholic gastritis and obstinate constipation. The 
dose of the tincture is 0.5 Cc. (8 minims). 

What part of aconite is used in medicine? What is the 
alkaloid of aconite? 

Aconite is derived from the root of the aconitum napellus. 
Its most important alkaloid is aconitine. 

- Write a prescription for corrosive sublimate to be used 
as a parasiticide. 

Jan. 1, 1903. Foe, John Jones. 

Hydrargyri bichloridi gr. ii 

Unguenti petrolati f Jj i. 

M. et Sig. — Use locally. John Smith, M. D. 

How is liquor ammonii acetatis prepared? In what 
conditions is this preparation useful? 

Spirit of Mindererus is prepared by neutralizing dilute 
acetic acid with ammonium carbonate; it should be freshly 
made, as it soon deteriorates. It is an active diuretic if the 
body be cool, and a diaphoretic if the body be warm. In 
wineglassful doses it will counteract many of the immediate 
effects of alcohol. 

What is the common name of staphisagria? What are 
the therapeutic uses of staphisagria? 

Staphisagria, commonly known as stavesacre, is a violent 
emetic, cathartic and parasiticide. 

Mention the preparations of ammonia. What effect has 
ammonia on the heart? 

The official preparations are aqua ammoniae, aqua ammoniae 
fortior, linimentum ammoniae, spiritus ammonise, spiritus am- 
monise aromaticus. Moderate doses of ammonia increase the 
strength and rapidity of the heart, and this effect is produced 
by a direct stimulation of the heart and its accelerator nerves. 



550 THERAPEUTICS AND MATERIA MEDIC A. 

Write a compound prescription for an adult containing 
iron, quinine and opium in pill form for neuralgia. 

Jan. 1, 1903. John Smith. 

& . Pulveris opii gr. x 

Ferri sulphatis exsiccatse, 

Quininse sulphatis aa gr. xx. 

M. et fiant in pilulse No. 20. 

Sig. — One every four hours. John Jones, M. D. 

Define tincture and spirits. 

Tinctures are alcoholic solutions of medicinal substances- 
Spirits are alcoholic solutions of volatile substances, which 
may be solids, liquids or gases. Tinctures, with the exception 
of the tincture of iodine, are made from non-volatile bodies. 

Mention three drugs used to accelerate the action of the 
heart and give the dose of some preparation of each. 

Atropine; dose of atropine sulphate, 0.0004 Gm. (V 16(> 
grain). Nitro-glycerin ; dose of spirit, 0.05 Cc. (1 minim). 
Ammonia; dose of the aromatic spirits, 2 Cc. (30 minims). 

Give the treatment of obstinate hiccough. 

Rhythmic traction of the tongue will often arrest obstinate 
hiccough. Ether as a spray to the epigastrium for ten min- 
utes, then to the site of the phrenic in the neck, is also ad- 
vised. Morphine hypodermatieally, either alone or in combi- 
nation with atropine, has sometimes proven effective. 

What is the physiologic effect of cocaine on the ocular 
conjunctiva, the pupil of the eye and the salivary and 
sweat glands. 

Cocaine dropped upon the conjunctiva causes dilatation of 
the pupil and profound anesthesia of that membrane ; it also 
produces partial paralysis of accommodation, slight lachry- 
mation, and sometimes temporary ptosis. It lessens the 
secretion of the salivary glands and the sweat glands. 



THERAPEUTICS AND MATERIA MEDICA. 551 

Write a prescription for a syphilitic adult containing 
corrosive sublimate and iodide of potassium in solution. 

Jan. 1, 1903. For John Jones. 

R . Hydrargyri chloridi corrosivi gr. i 

Potassii iodidi 3 ii 

Tinctune gentianse comp f J iii. 

M. et Sig. — A teaspoonful thrice daily after meals. 

John Smith, M. D. 

What are the therapeutic uses of tar? 

Tar is used as a stimulating expectorant and as a stimulant 
to the skin in certain chronic inflammatory diseases. 

What are the physiologic effects and therapeutic uses of 
chromic acid? 

Chromic acid exerts a powerful caustic effect upon all ani- 
mal tissue. It has a destructive action upon micro-organisms, 
and from the readiness with which it parts with its oxygen it 
rapidly decomposes organic matter, and so serves as a disin- 
fectant. It is not employed internally. It is a useful escha- 
rotic for destroying corns, warts, syphilitic vegetations, and 
the like. 

Give the source and state the uses of thymol. 

Thymol is a phenol obtained from the volatile oil of thyme 
and certain other volatile oils. Thymol is used as a disin- 
fectant in the form of a wash, as an ointment in chronic skin 
diseases, and internally as an efficient antiseptic. 

What is the dose of croton oil as a cathartic? What are 
the contraindications to its use? 

The dose is 0.05 Cc. (1 minim), given in glycerin or olive 
oil. It is contra-indicated when either debility, organic ob- 
struction, or inflammatory conditions of the stomach or 
bowels exist. 

What are the physiologic effects and therapeutic uses of 
cubebs? 

Cubebs is an aromatic stomachic and a stimulant diuretic 



552 THERAPEUTICS AND MATERIA MEDIC A. 

in small or medium dose, but large amounts derange digestion* 
and may act as a gastro-intestinal irritant. Its constituents 
are eliminated by the bronchial mucous membranes, the skin 
and the kidneys, stimulating and disinfecting the genito- 
urinary passages, increasing the bronchial mucus, sweat and 
urine, and frequently causing an urticarial or vesicular erup- 
tion. It increases the action of the heart and the vascular 
system and promotes the menstrual discharge. Cubebs is 
used in the acute stage of gonorrhea, in chronic cystitis and 
chronic bronchitis. It is applied in powder form in hay 
fever, chronic nasal catarrh and follicular pharyngitis. 

Mention the therapeutic uses of carbolic acid except as 
an antiseptic. 

It is used as a caustic, local anesthetic, as an anti-emetic 
and carminative. 

-- What is the treatment of scabies? 

Sulphur, styrax and naphthol are efficient local applica- 
tions as ointments. 

An excellent formula is the following : 

Sulphur sublimat - 3J 

Balsam Peruvians % ss 

Adipis | j 

M. et Sig. — Rub in thoroughly twice a day. 

How does an antagonist differ from an antidote? 

Antagonists are agents which oppose each other in their 
physiologic action, and may be employed against each other 
as counter poisons to neutralize their effects upon the organ- 
ism. They do their work in the blood and tissues after ab- 
sorption, and are especially available against poisons admin- 
istered hypodermically, in which case antidotes are useless. 
Antidotes affect a poison so as to remove it from the body or 
alter its character before absorption, and thereby prevent its 
toxic action on the organism. They do their work in the ali- 
mentary canal or in the respiratory passages. (Potter.) 



THERAPEUTICS AND MATERIA ME DIG A. 553 

Name and describe the methods of introducing medicines 
into the circulation. 

Medicines may be introduced into the circulation by vari- 
ous routes, including the mouth, the stomach, the rectum, the 
respiratory tract, the veins and arteries, the subcutaneous 
cellular tissues, and the skin. Intravenous medication is only 
used in emergencies where immediate action is desired. 
Saline solution is the usual remedy introduced by this route. 
The rectum will absorb any substances applied in the form 
of enemata or suppositories. The hypodermic method is the 
introduction of medicines into the organism by injecting them 
into the subcutaneous tissue, from which they are quickly 
absorbed by the lymphatic and capillary vessels. The respi- 
ratory tract admits of the rapid absorption of medicinal 
substances through its extensive blood supply, especially by 
inhalation. The stomach is the most convenient organ for 
the absorption of medicine. The remedies find their way into 
the current of the circulation through the walls of the gastro- 
intestinal blood-vessels and the lacteals. 

How do strophanthus and digitalis differ in physiologic 
action? 

Compared with digitalis, strophanthus is a powerful car- 
diac stimulant, differing from digitalis in not producing 
vasomotor constriction of the arterioles. It reduces the pulse, 
lowers body temperature somewhat, is not cumulative in 
action, and does not cause any gastro-intestinal disturbance. 
It is a diuretic by direct stimulation of the renal circulation, 
and has power over rigors by its rapid cardiac action, stop- 
ping them and preventing their recurrence. 

Mention the official turpentines. State from whence 
they are obtained. 

There are two official turpentines, terebinthina, a concrete 
oleoresin from Pinus palustris, the yellow pine, and other 
species of Pinus, natural order Oonif erge ; Terebinthina cana- 



554 THERAPEUTICS AND MATERIA MEDIC A. 

densis, a liquid oleoresin obtained from Abies balsamae, the 
balm of Gilead. 

Compare opium and belladonna as to action on the heart. 

Medicinal doses of belladonna quicken the pulse and raise 
the arterial pressure; the quickening of the pulse results 
from depression of the inhibitory nerves and stimulation of 
the accelerators. The increased blood pressure is due to stim- 
ulation of the vasomotor centers and the heart itself. Toxic 
doses paralyze the heart. Opium in moderate doses has little 
effect upon the circulation. Large doses, however, stimulate 
the inhibitory nerves, centrally and peripherally, and thus 
slow the pulse ; at the same time the latter becomes full and 
strong from stimulation of the heart or its contained ganglia, 
and possibly also from stimulation of the vasomotor centers 
in the medulla. Toxic doses finally paralyze both the heart 
and vagi and produce a rapid, feeble pulse. 

What are the therapeutic uses of ammonium carbonate? 

It is used principally as a stimulant in low fevers, like 
typhoid, and in acute pulmonary diseases associated with 
cardiac and respiratory weakness, such as croupous pneu- 
monia, catarrhal pneumonia and capillary bronchitis. 

Define solvent. Mention three principal solvents. 

Solvent is the term applied to the liquid before the sub- 
stance is added to it, by which addition after the operation is 
completed the combined preparation is called a solution. The 
chief solvents are water, alcohol and glycerin. 

What is the source of aloes? By what part of the intes= 
tinal tract is it eliminated? 

Aloes is the inspissated juice of the leaves of the Aloe soco- 
trina and other species of aloe. It acts chiefly on the lower 
half of the large intestine. 

Describe the physiologic action of alum. In what patho= 
logic conditions is alum useful? 

Alum is an astringent, coagulating the albumin and stim- 



THERAPEUTICS AND MATERIA MEDIC A. 555 

ulating muscular contraction. At first it excites the flow 
of saliva and then diminishes it. It coagulates pepsin and 
arrests digestion, stops peristalsis and usually causes consti- 
pation, although sometimes it produces diarrhea. Although 
coagulating albumin even in weak solution, it enters the 
blood, arrests secretion, especially those of mucous surfaces, 
and stops capillary hemorrhages. It is used locally as an 
astringent in chronic catarrh, leucorrhea, gonorrhea, hemor- 
rhoids, bed sores, colliquative sweats, etc. The dried powder 
is escharotic, destroying granulation and warty growths. 
Alum is used as an emetic in smaller doses in gastric catarrh, 
gastralgia, lead colic, etc. 

Mention the ingredients of (a) Tully's powder, (b) 
Dover's powder. 

(a) Tully's powder is the compound powder of morphine. 
It is composed of morphine sulphate 1 part, to 19 of camphor 
and 20 each of liquorice and calcium carbonate, (b) Dover's 
powder contains 10 parts ipecac, 10 parts of powdered opium 
and 80 parts of sugar of milk. 

Why is atropine combined with morphine when the 
latter is administered? What is the dose of atropine 
when combined with morphine? 

Atropine has long been regarded as the physiological an- 
tagonist of opium. It especially combats the depressing 
effect of opium on the circulation. The hypodermic dose of 
atropine sulphate when combined with morphine is 1-150 
grain. 

Give the therapeutic uses of sodium phosphate. 

In doses of % ounce it is a mild purgative. It has been 
recommended in catarrhal jaundice and cholelithiasis. 

State the ingredients and uses of sulphur ointment. 

Sulphur ointment is made up of 15 parts of washed sul- 
phur and 85 parts of benzoinated lard thoroughly mixed. 
Sulphur ointment is used in certain forms of skin diseases 



556 THERAPEUTICS AND MATERIA MEDICA. 

and as a means of administering sulphur when it is not well 
borne by the stomach. 

Give the composition and the chief use of lotio hydrar= 
gyri nigra. 

Black-wash is prepared by adding 30 grains of calomel to 
10 ounces of lime-water, thereby producing the black oxide, 
and is used as an application to syphilitic sores. 

What are the therapeutic uses of Pulsatilla? 

Some therapeutists regard the drug as of no value what- 
ever; others claim good effects from its employment as an 
emmenagogue, a diuretic and diaphoretic ; it is also a cardiac 
and vascular sedative, and possesses some antipyretic action. 

Where is quassia indigenous? What part of the plant 
is used in medicine? 

The "West Indies. The wood is used. 

What is the common name of ferrous sulphate? Give 
the chief uses of ferrous sulphate. 

Copperas: it is impure ferrous sulphate. It is chiefly 
used to make the dry sulphate and other preparations. It is 
sometimes employed as a tonic astringent. 

Describe the physiologic action and the therapeutic use 
of guarana. 

Guarana has similar actions to those of coffee, the active 
principle of both plants being perhaps identical. It may be 
used in migraine, in convalescence in acute diseases, in diar- 
rhea of phthisis, etc. 

Give the composition of Vienna paste (pasta caustica 
Yiennensis). 

It is a grayish-White deliquescent powder consisting of 
equal parts of potassa and lime rubbed together. 

Explain the distinction between physiologic action and 
the therapeutic use of medicinal agents. 

The physiologic action of a drug is its effect upon the 



THERAPEUTICS AND MATERIA MEDIC A. 557 

economy in health., and includes its action upon the nervous, 
centers, respiration, circulation and metabolism. From its 
physiologic action is deduced its therapeutic indication or 
employment in certain diseased states.. 

Define a mydriatic. Give three examples, with the dose 
for the local application in each case. 

Mydriatics are agents which produce dilatation of the 
pupils. Atropine is used locally in solutions of 8 grains to 
the ounce. Homatropine, in strength of 4 grains to the ounce. 
Cocaine locally in a 5 per cent, solution. 

Define germicides, parasiticides. 

Germicides are agents that destroy germs, as solutions of 
bichloride of mercury, permanganate of potash, carbolic acid, 
etc. Parasiticides are agents which are destructive to para- 
sites; the principal parasiticides are mercurial ointment, sul- 
phur and acetic acid. 

What results from combining silver nitrate and creo= 
sote? 

An explosive compound, which is white in color, without, 
odor, and has the appearance of an emulsion. 

What symptoms are produced by toxic doses of tartar 
emetic? 

Pain, vomiting, diarrhea, with watery stools and collapse, 
motor and sensory paralysis and suppression of the urine. 

Mention two remedies commonly used to increase in- 
testinal peristalsis. 

Senna and rhubarb. 

What are the therapeutic uses of buchu? 

Chronic affections of the genito-urinary mucous membranes, 
lithiasis, prostatic affections, atonic dyspepsia and chrome 
rheumatism. 



558 THERAPEUTICS AND MATERIA MEDIC A. 

What is the ultimate effect on the heart's action of 
medicinal doses of belladonna? 

Following the ingestion of belladonna the heart rate is at 
first slowed, but soon* becomes rapid and vigorous, and the 
arterial tension is increased ; this is accomplished by stimula- 
tion of the cardiac sympathetic and paralysis of the pneumo- 
g;astric, thus stimulating the accelerator apparatus while 
lessening the inhibitory. 

Compare the strength of dilute hydrochloric acid with 
that of the absolute acid. What is the dose of the former? 

Dilute hydrochloric acid is a 10 per cent, solution of the 
absolute acid in water. Its dose is 1 Cc. (15 minims). 

How do styptics and hemostatics differ? Give an ex= 
ample of each. 

These are agents which arrest bleeding, styptics being those 
which are applied locally, as alum, and hemostatics those 
which are administered internally, as gallic acid. 

What part of zingiber is used in medicine? What are 
its therapeutic uses? 

The rhizome. The official preparations are fluid extract, 
tincture, syrup, and the oleoresin. It is employed as a car- 
minative and as an adjunct to purgative medicine to prevent 
griping; the syrup is commonly employed as a flavoring ad- 
juvant. 

Define pharmacy. 

Pharmacy is the art of selecting and preserving medicines 
and preparing them for administration. 

How do therapeutic agents act to promote waste? 

Destructive metamorphosis of the tissues is promoted by 
alteratives and astringents. The manner in which alteratives 
act has never been determined. We know that of such drugs 
as mercury and iodine, the former being endowed with the 
power of breaking up newly-deposited fibrin and disorganiz- 



THEBAPEUTICS AND MATERIA MEDICA. 559 

ing syphilitic deposits, and the latter acts energetically upon 
the lymphatic system and promotes absorption. 

Mention the principal therapeutic application of anti= 
pyrine. 

Antipyretic, analgesic, antiseptic, as a local anesthetic and 
to diminish secretion, as an anti-galactagogue. 

What is the dose of curare for hypodermic use? What 
are the antagonists of curare? 

Dose V 20 to % grain. Strychnine, atropine, and more ef- 
fective still, artificial respiration. 

What is codeine? State the dose of codeine. What are 
the advantages of codeine over opium? 

Codeine is an alkaloid of opium, differing from morphine 
in having the radical CH 3 replacing an atom of hydrogen. It 
is less irritating to the digestive tract than opium. Its dose 
is 0.030 Gm. (% grain). 

Mention the therapeutic uses of creosote. 

Locally as an anesthetic and antiseptic. Internally as an 
antiseptic, in chronic gastric catarrh, in diarrhea, dysentery 
and phthisis. 

What is the common name of hamamelis? State the 
dose of the fluid extract of hamamelis. 

Witch-hazel. The dose of the fluid extract is 2 Cc. (30 
minims) . 

What part of buchu is used in medicine? State the dose 
of the fluid extract of buchu. 

The leaves. Dose of the fluid extract 2 Cc. (30 minims). 

What is the official name of tartar emetic? State the 
dose of tartar emetic. 

Antimonii et potassii tartras. Dose as expectorant, 0.005 
Gm. (V 10 grain) ; as emetic, 0.030 Gm. (y 2 grain). 



560 THERAPEUTICS AND MATERIA MEDICA. 

What are the uses of cantharis (a) externally applied, 
(b) internally administered? 

Externally it is employed as a vesicant and internally as a 
stimulant to the genito-urinary tract. 

What is pepo? State its therapeutic use. 

Pumpkin-seed. It is used as an anthelmintic against tape- 
worms. 

Describe the physiologic action and the therapeutic uses 
of scammonium. 

Scammony is a powerful irritating hydragogue cathartic. 
It may be used in combination with other cathartics in obsti- 
nate constipation. 

Mention the preparations of ergot and give the dose of 
each preparation. 

The extract of ergot, dose 0.250 Gm. (4 grains) ; the fluid 
extract, dose 2 Cc. (30 minims) ; the wine, dose 8 Cc. (2 fluid- 
drachms). 

Define hematics. Mention two principal hematics. 

These are medicines which increase the quantity of hematin 
in the blood. They consist chiefly of iron and manganese 
and their compounds. 

What are the physiologic effects of iodoform internally 
administered? State the therapeutic uses of iodoform 
when externally applied. 

In small doses internally iodoform is considered to be a 
tonic and alterative. If taken over a protracted period it may 
cause profuse salivation. In toxic doses it causes pyrexia, 
then headache, quick and feeble pulse, marked anxiety and 
restlessness; collapse and death may suddenly supervene. 
Locally its action is anesthetic and powerfully antiseptic. It 
is one of the best agents to prevent decomposition, and it 
destroys the germs of putrefaction and of disease, but must 
be carefully employed. 



THERAPEUTICS AND MATERIA MEDIC A. 561 

Give the dose of (a) liquor potassii arsenitis, (b) liquor 
sodii arsenatis. 

(a) 0.2 Cc. (3 minims), (b) 0.2 Cc. (3 minims). 

Define emulsion. 

Emulsions are liquid preparations containing an insoluble 
medicinal substance, as an oil or a resin, in a state of minute 
subdivision, and suspended by the aid of some viscid excip- 
ient, as gum, which may be contained in the medicinal ingre- 
dient itself or be added by the pharmaceutist. 

Where is the habitat and what are the physiologic 
effects of digitalis? 

It grows wild in Europe and is cultivated in this country. 
The dominant action of digitalis is on the circulation. In 
therapeutic doses it slows the pulse and raises the blood pres- 
sure. The slowing of the pulse results from a prolongation 
of the diastole, and this in turn is due to stimulation of the 
vagi or inhibitory nerves. The increased blood pressure is 
due to a powerful stimulant effect on the heart and to a con- 
traction of the arterioles resulting indirectly from stimula- 
tion of the vasomotor center and directly from the action of 
the drug on the vessel wall. Toxic doses quicken the pulse 
by paralyzing the vagi and lower the arterial pressure by 
causing a powerful systolic contraction so that the diastole 
becomes too imperfect to permit the ventricles to be completely 
filled. Therapeutic doses have no effect on the nervous sys- 
tem, but toxic doses lessen the reflexes, first by stimulating 
Setschenow's inhibitory centers, and later by depressing the 
spinal cord. It requires toxic doses to influence the respira- 
tion, and then slowing occurs. Large doses occasionally pro- 
duce nausea, vomiting and diarrhea. In health, digitalis has 
little or no diuretic action. When the urine is diminished 
from embarrassment of the circulation it produces free diur- 
esis, which is attributed to its effect on the heart and vessels, 
and not to a direct influence on the secreting structure of 
the kidney. 
36 



562 THERAPEUTICS AND MATERIA MEDICA. 

State the source of ichthyol and give its uses in medi= 
cine. 

Ichthyol is prepared from the product of the distillation of 
bituminous rocks from the Tyrol, which contain fossil fishes. 
It is useful in certain chronic skin diseases, particularly 
eczema and psoriasis. It is extensively used externally for 
its antiseptic and alterative properties in rheumatism, erysip- 
elas and lymphatic enlargements. Combined with glycerin, 
it is valuable, locally applied, in the various inflammatory 
affections of the female genital organs. 

What are the therapeutic uses of aconite? Give the 
dose of the fluid extract of this drug. 

Aconite is used locally in neuralgia; internally in hyper- 
emesis, in acute inflammation, such as tonsillitis, bronchitis 
and pneumonia, in excessive hypertrophy of the heart, in 
nervous palpation, in the tachycardia of exophthalmic goiter 
and in active cerebral congestion with high arterial tension. 
Dose of fluid extract is 0.05 Cc. (1 minim). 

What part of scoparius is used in medicine? What 
alkaloid is derived from scoparius? 

The tops of cytisus scoparius. Its alkaloid is sparteine. 

Give the common name of taraxacum and state what 
part of this plant is used in medicine. 

Dandelion. The root is used in medicine. 

What is the physiologic action of tincture of the chlor= 
ide of iron upon the kidneys? 

The tincture of the chloride is considered diuretic. 

Give the chief source and the dose of gallic acid. 

It is prepared from a paste of powdered galls by ferment- 
ing for six weeks, boiling and reboiling in water, filtering 
and crystallizing. Dose, 1 Gm. (15 grains). 



THERAPEUTICS AND MATERIA MEDICA. 563 

Give the dose of hyoscine for hypodermic use. For what 
purpose is hyoscine used? 

The dose of hyoscine hydrobromide hypodermically is 
0.0005 Gm. ( 1 / 128 grain). Hyoscine is a cerebral and spinal 
sedative, a powerful hypnotic. It is employed as anodyne 
when opium is contra-indicated. 

What is an excipient? Give examples. 

Excipients are substances which give form and consistence 
to prescriptions, and serve as vehicles for the exhibition of 
the other ingredients. Examples are syrups, acacia and the 
various flavoring agents, such as syrup of lemon. 

Describe the technique of venesection. 

The patient having been placed in a semi-recumbent posi- 
tion, the arm should be constricted three or four inches 
above the elbow by a few turns of a roller or a twisted hand- 
kerchief ; if this is not sufficient to render the veins prom- 
inent, the arm may be rubbed for a few minutes from below 
upwards. A large vein having been selected, it should be 
incised by a thumb-lancet or a spring-lancet in a direction 
oblique to the long axis of the vessel. The amount of blood 
abstracted will depend entirely upon the pulse, which should 
be carefully observed during the operation, and when it les- 
sens in force and becomes more compressible the bleeding 
must be suspended. 

Define glucosides and give two examples. 

Glucosides form a group of organic principles existing in 
plants, and are generally neutral in character. Examples 
are salicin, obtained from willow and other barks, and glycyr- 
rhizin, from liquorice root. 

What is the most active laxative ingredient in pulvis 
:glycyrrhizae compositus? 

Senna. 



564 THERAPEUTICS AND MATERIA MEDICA. 

By what methods do antipyretics act? Give an example 
of one that acts by each method. 

Antipyretics reduce the body temperature in fever: (a) 
by lessening the production of heat — (1) by diminishing 
tissue change, (2) reducing the circulation; or (b) promot- 
ing the loss of heat — by (3) dilating the cutaneous vessels;, 
(4) producing perspiration, and (5) abstracting heat from 
the body. Examples of antipyretics acting in the order 
named are as follows: Quinine (1), digitalis (2), carbolic 
acid (1 and 3), antipyrine (1 and 4), cold sponging (5). 

Indicate the common name and give the preparations of 
serpentaria. 

Virginia snake-root. The preparations are the fluid ex- 
tract and the tincture. It also is one of the components of 
compound tincture of cinchona. 

What are the therapeutic uses and the official prepara= 
tions of oleic acid? 

Oleic acid is used only in making the oleates. Three prep- 
arations are official, the oleate of mercury, the oleate of vera- 
trine and the oleate of zinc. 

What is the antidote for strychnine? 

Chloral hydrate. 

Describe the manner of making barley water as food 
for the patient. 

It may be made as follows : Grind % ounce of pearl barley 
in a coffee-mill, add 6 ounces of water, boil 20 minutes, add 
salt and strain. 

What are the therapeutic uses of the preparations of 
silver? 

The nitrate is the most soluble of the silver salts ; it is anti- 
septic, astringent, hemostatic, irritant, and a limited escha- 
rotic, also anti-phlogistic, anti-spasmodic and tonic. The 
oxide is the least irritant, and does not discolor the skin so 



THERAPEUTICS AND MATERIA MEDIC A. 565 

quickly. Internally it has been used in gastric neuralgia, irri- 
table dyspepsia, pyrosis, gastric and pulmonary hemorrhages, 
dysmenorrhea, menorrhagia, to check profuse sweating, to 
-control vomiting, and in diarrhea depending on reflex nervous 
irritation. The iodide is similarly employed. 

How would you distinguish chemically between ether 
- and chloroform? 

Ether is ethyl oxide (C 2 H 5 ) 2 0. Chloroform is trichlor- 
methane, CHC1 3 . 

Name four drugs used in the treatment of chronic inter= 
stitial nephritis. 

Nitroglycerin, Basham's mixture, caffeine, and magnesium 
sulphate. 

_ Give the therapeutic uses of caffeine. 

Cardiac stimulant in cardiac and renal dropsy, and alone 
or in combination with antipyrine or the bromides in nervous 
headache and migraine. 

_ Describe the physiologic action of aconite. 

It is a powerful depressant of the sensory nerve ends, the 
niervous and muscular apparatus of the heart and respiration, 
.and the spinal nervous system. It is also antipyretic, dia- 
phoretic and diuretic. 

Name the official preparations and doses of digitalis, 
cascara sagrada and ipecacuanha. 

Digitalis, the extract, dose 0.010 Gm. (i/ 5 grain) ; the fluid 
extract, 0.05 Cc. (1 minim) ; the infusion, 8 Cc. (2 fluid- 
rachms) ; the tincture, 1 Cc. (15 minims). Cascara sagrada, 
the fluid extract, dose 1 Cc. (15 minims). Ipecacuanha, the 
fluid extract, emetic dose 1 Cc. (15 minims) ; expectorant 
dose 0.05 Cc. (1 minim) ; Dover's powder, 0.500 Gm. (7% 
grains) ; the syrup, emetic dose 15 Cc. (4 fluidrachms), ex- 
pectorant dose 1 Cc. (15 minims) ; wine of ipecac, dose 1 
Cc. (15 minims). 



566 THERAPEUTICS AND MATERIA ME DIG A. 

Name four efficient hypnotics and give the source and 
dose of each. 

Sulphate of morphine derived from opium, dose 0.015 Gm. 
(14 grain) ; hyoscine, an alkaloid of hyoscyamus, dose of the 
hydrochloride, 0.0005 Gm. (V 128 grain) ; chloral hydrate ob- 
tained from the action of chlorine on aldehyde, dose 1 Gm. 
(15 grains) ; sulphonmethane, or sulphonal, a synthetic prod- 
uct obtained by the oxidation of a mixture of ethyl-mercaptan 
and acetone, dose 1 Gm. ( 15 grains) . 

- Write a prescription for (a) a collyrium, (b) a supposi- 
tory, and (c) a mouth=wash. 

( a ) R . Acidi borici gr. x 

Aquse camphorse. 

Aquse destillatse aa q. s. ad f ^ j 

Sig. — Fifteen drops in both eyes thrice daily. 

( b ) 13c . Pulveris opii gr. j 

Iodoformi gr. j 

Olei theobrom. q. s. 
Fr. in suppositoria No. 1. 
Sig. — Use on retiring. 

( c ) & . Potassii chloratis gr. lxxx 

Aquse laurocerasi f 3 viij 

M. S. — Use as mouth-wash. 

— Name five antiseptics and tell in what proportions each 
should be diluted for surgical purposes. 

Bichloride of mercury, 1 to 1000. Permanganate of po- 
tassium, 25 grains to the pint. Boric acid, 15 grains to the 
ounce. Carbolic acid, 5 per cent, solution in glycerin and 
water. Peroxide of hydrogen, the full strength of the offi- 
cial preparation is 3 per cent. 

Describe the physiologic action of hyoscine and name a 
physiologic antidote. 

It is a cerebral and spinal sedative and powerful hypnotic, 
directly depressing the higher function of the brain and" 
affecting the heart but feebly. Tannin and morphine. 



THERAPEUTICS AND MATERIA MEDIC A. 567 

Give the composition of the official compound cathartic 
pill. 

Compound extract of colocynth, 80 parts; resin of jalap, 
20 parts ; mild chloride of mercury, 60 parts ; gamboge, 15 
, parts. 

Describe two escharotics and tell how you would apply 
them. 

Nitrate of silver applied in the form of lunar caustic is an 
efficient superficial escharotic ; carbolic acid is escharotic, and 
should be used in strong solution, 1 to 10. 

Write a correct prescription containing nitrate of silver. 

Argenti nitratis gr. iij 

Gum Tragacanth, q s. 
Ft. — In pil. no. xii. 
Sig. — One before meals. John Jones, M. D. 

State the direct and indirect effect of pilocarpine in 
dropsical effusion. 

It causes prompt and profuse perspiration and salivation, 
increases the bronchial and lachrymal secretion, and some- 
times causes serous diarrhea. Full doses cause a decrease in 
arterial tension. The elimination of urea is greatly increased, 
but not the quantity of the urine. 

What are the physiological effects of nux vomica on the 
nerves and circulatory system? 

It is a powerful stimulant of the spinal cord, especially the 
motor columns. In toxic doses it produces spinal convul- 
sions. Small amounts stimulate the brain and increase the 
mental powers. In moderate doses the heart is stimulated and 
the arterial pressure raised by stimulation of the vasomotor 
center in the medulla. 

What is wrong with the following prescription? 

R . Argentae nitratis drams, one. 

Sodi chloridum drams, four. 

Syrupus lemonis, q. s ounces, four. 

Sig. — Take a tablespoonful after meals in water. 



568 THERAPEUTICS AND MATERIA MEDICA. 

Argentce should read argenti; sodi chloridum should read 
sodii chloridi; syrupus lemonis should read syrupus limonis. 
This prescription affords the example of a pharmaceutical 
incompatibility. Nitrate of silver should not be compounded 
with sodium chloride, for there results the insoluble chloride 
of silver. 

Write for an adult a complete prescription for a diarrhea 
mixture containing three remedies and the excipient. 

8 . Cretse preparatse 3 ii 

Tincturpe catechu '. - % ss 

Tincturae opii * TT^lxxx 

Aqua cinnamomi ad f 3 viii 

M. Sig. — Two teaspoonfuls every four hours. 

Name the official preparations of belladonna and the 
dose of those used internally. 

Extraetum belladonna? foliorum, dose 0.010 Gm. (J grain) ; 
tinctura belladonnas foliorum, dose 0.5 Cc. (8 minims) ; fluid- 
extractum belladonnas radicis, dose 0.05 Cc. (1 minim) ; em- 
plastrum belladonnas ; unguentum belladonnas. 

Write a prescription containing oil of sandal wood and 
at least one other constituent for chronic cystitis. 

Jan. 1,1903. For William Smith. 

R . Olei santali. f J i 

Salol J i 

Ft. in Capsules no. xii. 

Sig — One after meals. Wm. Jones, M. D. 

Define narcotics, anesthetics and sedatives, and give an 
example of each. 

Narcotics are agents which lessen pain and produce sleep 
or stupor; example, opium. Anesthetics are agents which 
temporarily destroy sensation; they are both general and 
local; example, ether as a general anesthetic and chloride of 
ethyl as a local anesthetic. Sedatives are agents which exert 
a soothing influence on the system by lessening functional 
activity, depressing motility and diminishing pain; example, 
the bromides. 



THERAPEUTICS AND MATERIA MEDIC A. 569 

Treat a case of opium poisoning; also give the thera= 
peutic uses of opium. 

The stomach should be emptied by the stomach-pump or a 
stimulating emetic, like sulphate of zinc or mustard. Pre- 
vious to this, however, if the opium is in the stomach, solution 
of permanganate of potash should be administered freely ; as 
a chemical antidote strong coffee should be given, and the 
patient should be aroused by flagellation, douching, or forced 
walking. Atropine and strychnine should be given hypo- 
dermically. The temperature should be maintained by the 
external application of heat, In therapeutics opium is used 
internally to produce sleep, to relieve pain, to lessen nervous 
excitement, to promote diaphoresis, to check hemorrhage, and 
to support the system. Externally it is used as a sedative. 

Name five emetics and give the dose of each. 

Alum, dose 1 to 4 drams; mustard, dose 1 to 4 drams; 
ipecac, dose of the fluid extract 15 minims; apomorphine, 
dose V 10 grain; sulphate of zinc, dose 15 grains. 

What are the advantages and disadvantages in the use 
of choloroform as an anesthetic and what are the signs in= 
dicative of danger in the patient? 

Inhalations of chloroform produce sensations which are 
rather agreeable than otherwise, while the first stage of ether 
anesthesia is decidedly unpleasant. Chloroform produces 
anesthesia more quickly than ether, and in certain cases this 
is an advantage. It is, however, much more dangerous than 
ether. Its dangerous symptoms are: (1) respiration becomes 
stertorous or shallow; (2) sudden dilatation of the pupils; 
(3) signs of cardiac failure. Chloroform produces much less 
subsequent vomiting. 

Define briefly but clearly serum therapy. 

Serum therapy properly means the prophylactic and cur- 
ative treatment of certain acute infectious diseases by the 
subcutaneous injection of a blood serum containing an anti- 



570 THERAPEUTICS AND MATERIA MEDIC A, 

toxin specific to the particular disease. As generally used, 
however, this term includes the treatment of the same dis- 
orders by the toxins produced by attenuated cultures of their 
respective microbes; but these toxins, though sometimes 
grown on blood serum, may be cultivated on other media, 
and are never administered in a serum, as the antitoxins in- 
variably are. The antitoxins at present employed in serum 
therapy are those of diphtheria, tetanus, tuberculosis, erysip- 
elas, pneumonia, cholera, syphilis, plague, and typhoid fever, 
but only the first three have come into anything like general 
use. (Potter.) 

What official preparations are derived from the willow? 

Salicinum or salicin, a glucoside, is obtained from several 
species of the willow. Salicylic acid and the various sali- 
cylates might be prepared from salicin by synthetic processes 
but practically this is never done. 

What active principles are found in digitalis? What 
are the official preparations of petroleum? 

Digitalin, digitoxin, digitalein, digitonin, and digitin. Pe- 
trolatum is a mixture of the hydrocarbons obtained from 
petroleum. The official preparations are petrolatum, petro- 
latum album, and petrolatum liquidum. 

Give the physiologic action and therapy of saline pur= 
gatives. 

This group includes the neutral salts of metals of the alka- 
line or alkaline earths. They stimulate the intestinal glands 
to increased secretion, and by their low divisibility impede 
re-absorption, causing an accumulation of fluid in the intes- 
tinal tract. This, partly from the effect of gravity and partly 
by gentle stimulation of peristalsis excited by distension, 
reaches the rectum and produces a copious evacuation. Mag- 
nesium sulphate and sodium sulphate are the typical salines. 
They should be given in plenty of water and during active 



THERAPEUTICS AND MATERIA MEDIC A. 571 

movement (as in walking) in order to produce their best 
effects. 

_ Name three drugs used in the treatment of intermittent 
fever. State how each controls this disease. 

Quinine exerts a specific influence in all malarial infections 
by reason of its power to prevent the development of the 
Plasmodium to which malaria is due. A 10-grain dose of the 
sulphate should be given in the sweating stage, and again 
five hours before the expected time of the next paroxysm. In 
the intervals arsenic is of more value ; its therapeutic action 
is due to the fact that it is a valuable anti-periodic, as well 
as tonic and alterative. Mercury is also of value for its 
hematinic and alterative properties. 

Describe the treatment of intestinal indigestion. 

Under this term a variety of conditions have been described 
dependent upon various causes, but it is usually restricted to 
acute or chronic intestinal catarrh. When this is dependent 
upon causes residing in the stomach the existing gastritis 
must be first treated. A course of calomel and soda is of 
value; this may be followed by the administration of pan- 
creatin, which will aid digestion. Proper measures of diet 
and exercise are important. Charcoal in 10-20-grain doses is 
useful. 

Name four drugs incompatible with tannic acid. Name 
two incompatible with hyoscyamus. 

Tartar emetic, lead acetate, silver nitrate and hydrochloric 
acid are incompatible. The hydroxide of potassium and 
tannin with hyoscyamus. 

What doses of antitoxin are used for a child five years 
old ill with diphtheria? What would be the prophylactic 
dose for the same child? 

1500 units. 500 units. 



572 THERAPEUTICS AND MATERIA MEDIC A. 
Correct the following prescription: 

& . Atropiae Sulphati grs. iss 

Potas. Iodidi J oz. 

Infusae Digitalis h, 11. oz. 

Elix. Siinpl. q. s. ad 2 fl. oz. 

M. S. — Teaspoonful in water four times a day. 

Potassium iodide is best given alone. The dose of atropine 
is much too great. It should be about V 100 grain to each 
dram. Atropice sulphati should read Atropines sulphatis. 
Infuses should read Infusi. 

What parts of gossypium are used in medicine? 

The bark of the root is official as gossypii cortex, and the 
hairs of the seed as gossypium purificatum. 

What is the important alkaloid of erythroxylon and 
what is its principal therapeutic use? 

Its alkaloid, cocaine, is allied to caffeine, but is more pow- 
erful, and its proportion in the leaves of the plant varies 
greatly in the different samples which occur in commerce. 
Its chief use is that of a local anesthetic. 

Name the official preparation of bismuth and give the 
dose of each. 

Bismuth citrate, 0.125 Gm. (2 grains) ; bismuth and am- 
monium citrate, 0.125 Gm. (2 grains) ; bismuth subcarbonate, 
0.500 Gm. (7y 2 grains) ; bismuth subgallate, 0.250 Gm. (4 
grains) ; bismuth subnitrate, 0.500 Gm. {iy 2 grains) ; bis- 
muth subsalicylate, 0.250 Gm. (4 grains). 

What is the physiologic action of iris? 

Iris when fresh is actively purgative, emetic and diuretic, 
producing severe nausea and prostration. 

What is the dose of (a) potassium iodide, (b) ammo= 
nium iodide, (c) sodium iodide? 

(a) 0.500 Gm. (7,% grains) ; (b) 0.250 Gm. (4 grains) ; 
(c) 0.500 Gm. (7% grains). 



THERAPEUTICS AND MATERIA MEDICA. 573 

From what is koumiss made and what are its thera= 
peutic uses? 

Koumiss is an effervescing fermented liquor originally pre- 
pared by the Tartars from mares' milk, but now imitated 
with cows' milk by adding sugar of milk, fermenting in an 
open tank, skimming off the casein and butter, then bottling 
during active fermentation. Koumiss is an invaluable article 
of diet in many wasting diseases, especially tuberculosis. It 
is of great benefit in dyspepsia, the diarrheas of children, 
convalescence from acute maladies, chronic affections of the 
kidneys, chronic bronchitis and other cachexias. 

What is the proportion of mercury in hydrargyrum cum 
creta? What is the dose? 

38% mercury. Dose, 0.250 Gm. (4 grains). 

Compare the therapeutic uses of pepsin and pancreatin. 
How are these remedies prepared? 

Pepsin is the digestive principle of gastric juice. Pan- 
creatin is a mixture of the enzymes naturally existing in the 
pancreas of warm-blooded animals. Pepsin is usually ob- 
tained from a solution prepared by digesting the mucus 
scraped from the rennet-bags of sheep or the stomach of the 
pig in acidulated water for several days. It is then precipi- 
tated by sodium chloride, lead acetate or alcohol. Pancreatin 
is usually obtained from the fresh pancreas of the hog. Pep- 
sin is employed in cases of gastric indigestion, while pancre- 
atin is indicated in intestinal indigestion. 

Describe the therapeutic action of spigelia. What are 
its therapeutic uses? 

Spigelia, pink root, is anthelmintic against the round-worm 
and is usually administered with senna. In large doses it is 
an uncertain cathartic, and may produce serious symptoms, 
including vertigo, dimness of vision, dilated pupils, and con- 
vulsions. 



574 THERAPEUTICS AND MATERIA MEDIC A. 

What are the therapeutic uses of cannabis and what is 
the dose of the tincture of cannibas indica? 

It is used as a sedative and soporific as a substitute for 
opium in such conditions as chronic bronchitis, phthisis, in 
the dyspnea of asthma, and in the restlessness of chronic 
nephritis. As an analgesic it is useful in neuralgia and mi- 
graine. It is also employed in mania, delirium tremens, and 
in some forms of dysmenorrhea and menorrhagia. The dose 
of the tincture is 0.6 Cc. (10 minims). 

What is the composition of hydrargyri iodidum rubrum? 

It is a red crystalline powder prepared by the double de- 
composition of potassium iodide, 5 parts, and mercuric 
chloride, 4 parts. 

Where is the cinchona tree indigenous? What part of 
the tree is used in medicine? 

It is a native of the eastern slope of the Andes. The bark. 

Name three drugs used to retard the heart's action and 
state the dose of some preparation of each. 

Aconite, dose of the tincture, 0.6 Cc. (10 minims) ; anti- 
mony, dose of tartar emetic 0.005 Gm. (V 10 grain) ; vera- 
trum, dose of the tincture 1 Cc. (15 minims). 

Describe the symptoms of hydrargyrism. 

The first symptoms of chronic mercurial poisoning are fetid 
breath, swollen and spongy gums having a bluish line along 
their margin, stomatitis, sore and loosened teeth, salivation. 
Anorexia, diarrhea and fever follow, also ulceration, and in 
some cases even gangrene of the lips and tongue. There is 
destruction of tissue and various nervous disturbances. The 
patient becomes emaciated, suffers from headache, insomnia, 
neuralgia and tremor, a vesicular or pustular eruption ap- 
pears, and finally there follow coma and convulsions. 

Give the common name and state the physiologic effects 
of mentha piperita. 

Peppermint. It is an aromatic stimulant, also carminative 



THERAPEUTICS AND MATERIA MEDIC A. 575 

and anti-spasmodic. It is used in the form of menthol, as 
an antiseptic and local anesthetic. Peppermint is employed 
internally for the relief of nausea and colic and as a car- 
minative. It is an agreeable corrigent for combination with 
purgatives to prevent griping. 

Of what is iodoform a preparation and what is the dose 
for internal administration? 

Iodoform contains from 94 to 97 per cent, of iodine. Dose, 
0.250 Gm. (4 grains). 

What are the sources of salicylic acid? 

Salicylic acid is an organic acid existing naturally in com- 
bination in various plants, but generally prepared synthet- 
ically from carbolic acid. 

Give the source and describe the uses of lanolin. 

Lanolin is the purified fat of the wool of sheep mixed with 
not more than 30 per cent, of water. It is useful in chronic 
skin diseases where there is infiltration and where a penetra- 
tive action is required for medicaments locally applied. 

How do oleates and ointments differ? 

Oleates are liquid solutions of metallic salts, or alkaloids in 
oleic acid intended for external administration. Ointments 
are soft, fatty mixtures of medicinal agents with a basis of 
lard, petrolatum, etc. They are intended for application to 
the skin by inunction, and have a melting point which is 
below the ordinary temperature of the human body. 

What are the therapeutic uses of acetanilide adminis= 
tered internally? Has it any uses when locally applied? 
If so, what are they? 

It is used internally as an antipyretic and an analgesic and 
antispasmodic. It is extensively employed in surgical prac- 
tice as a dry dressing for wounds, etc. 



576 THERAPEUTICS AND MATERIA MEDIC A. 

Describe linum and give its medical preparations and 
uses. 

Flaxseed is the seed of linum usitatissimum. It contains 
15 per cent, of mucilage in the epithelium, also 30 to 40 
per cent, of fixed oil in the embryo. Linseed oil is official. 
Linseed tea is in common use, but is not official. Carron oil, 
a favorite application for burns, consists of equal parts of 
linseed oil and lime-water. Linseed is demulcent, emollient, 
expectorant and diuretic. The oil is laxative in doses of 1 
ounce. The ground seed is used in making the linseed 
poultice* 

What are the symptoms of iodism? How may it be 
prevented while the use of the iodide is continued? 

The symptoms of iodism are anemia, emaciation and mental 
depression. There is frontal headache, ptyalism, a saline taste 
in the mouth, dysphagia, temporary impotence, and an erup- 
tion of acne on the face and limbs. The iodide of potash 
may be prescribed in combination with tincture of cinchona 
or with Fowler's solution, which prevents the iodic eruption 
to some extent. If the iodides are given freely diluted in 
water the toxic effects are less likely -to be produced. 

Give the common name of hydrastis and describe its 
therapeutic uses. 

The common name is goldenseal. It is used chiefly as a 
stomachic tonic and antiperiodic, a mild laxative and an 
antiseptic. It is of value in catarrhal inflammation of the 
gastro-intestinal and genito-urinary tract and as a local alter- 
ative and antiseptic application. 

Write the following prescription by the metric system: 

Potassii bicarb 3 J dr. 

Acidi acetici 7 fl . dr. 

Aquae 3 fl. oz. 

Potassii bicarb 13 5 

Acidi acetici 25 

Aquae 90), 



THERAPEUTICS AND MATERIA MEDIC A. 577 

What are the possible dangers from the use of salol in 
large doses? 

Salol breaks up in the body into salicylic acid and carbolic 
acid. It is apt to produce the symptoms of carbolic acid 
poisoning. 

Give the medical name and the official preparation of 
lignum vitae. 

Guaiacum. The official preparations are the tincture of 
guaiac and the ammoniated tincture. 

What are the therapeutic uses of manganese? 

The salts of manganese, especially the -permanganate of 
potash, are used in anemia, in irregularities of menstruation, 
as an antidote against opium or morphine in the stomach and 
locally, as an antiseptic and oxidizing agent. The dioxide 
is a good remedy in amenorrhea, gastrodynia and pyrosis, and 
in the form of an ointment for many skin diseases. 

How is the peroxide of hydrogen prepared? What are 
its therapeutic uses? 

By passing C0 2 through water containing Ba0 2 in suspen- 
sion, or by action of an acid on Ba0 2 . The U. S. P. solution 
contains, when freshly prepared, 3 per cent, of the pure 
dioxide, corresponding to about 10 volumes of available 
oxygen. This preparation is a non-toxic antiseptic. It is 
employed as a gargle or spray in quinsy, croup, diphtheria, 
scarlet fever, ozena, and for the purpose of cleansing wounds. 
It may possess some value as an intestinal antiseptic on ac- 
count of the fact that it is a valuable oxidizing agent. 

What are the therapeutic uses of uva ursae? What part 
of this plant is used in medicine? 

Bearberry is an astringent tonic, and is feebly diuretic. 
The leaves are employed. 

What is the common name of oleum morrhuae? On 
what physiologic effect does its therapeutic use depend? 

Cod-liver oil. The action of cod-liver oil is like that of 
37 



578 THERAPEUTICS AND MATERIA MEDIC A. 

any other fat except that it is more easily assimilated than 
any member of the class. Its beneficial effects, therefore, are 
derived solely from its food value. 

What is the composition of linimentum calcis? For 
what is it principally used? 

Carron oil consists of equal parts of lime-water and linseed 
oil, and is employed chiefly in burns. 

What action on the heart has valerian in full doses? 
State the therapeutic uses of valerian. 

In full doses it increases the action of the heart and raises 
the temperature. The oil in large doses lowers the blood 
pressure and slows the pulse. Valerian is used in hysteria, 
for the flatulence of infants and nervous subjects, also for 
coughs of nervous type, in whooping cough, diabetes insipi- 
dus and in delirium with vital depression. 

Where is jalap indigenous? What part of it is used in 
medicine? 

Jalap is a Mexican plant. The root is used. 

Mention the salts of silver used in medicine and give 
the dose of each. 

iSilver nitrate, dose 0.010 Gm. (% grain). Silver cyanide; 
this is not used in medicine except in the preparation of 
hydrocyanic acid. Silver oxide, dose 0.065 Gm. (1 grain). 

Describe the therapeutic uses of (a) water and (b) min= 
eral water. 

Gold water or ice has many external applications of value 
in the treatment of disease. As a wet pack it is used in ton- 
sillitis and diphtheria. The cold baths and the cold wet pack 
are the best methods of obtaining an antipyretic effect in 
fevers. Cold or ice water is applied to the head in acute 
cerebral congestion. Locally in orchitis, the uterus in post- 
partum hemorrhage. Hot water externally is most effective 
in reducing local congestion and setting up resolution of 



THERAPEUTICS AND MATERIA MEDIC A. 579 

local inflammation. The hot wet pack is highly esteemed in 
inflammations of the chest. The vaginal hot-water douche is 
serviceable in catarrhal conditions of the vaginal and cervical 
mucous membrane and congestive, swollen or neuralgic con- 
ditions of the ovaries, tubes and adjacent tissues. Vapor and 
Turkish baths are used in chronic kidney disease and as 
diaphoretics generally wherever a diuretic effect is desired. 
Internally, water is of value as a diuretic, and if hot as a 
diaphoretic. Mineral waters are esteemed most highly when 
they are of the class possessing aperient and purgative prop- 
erties. Depending upon the composition of these waters, they 
may be of value in chronic rheumatism, diabetes, obesity, 
syphilis, metallic poisoning, constipation, etc, 

Where is the cinnamon tree indigenous? Mention the 
active principle of cinnamon and give its dose. 

Ceylon. The active principle is a volatile oil, the dose of 
which is 0.05 Cc. (1 minim). 

What therapeutic uses has chloroform other than an 
anesthetic? 

It is used in intestinal colic and serous diarrhea, as a car- 
minative and as a sedative in cases of obstinate cough. 

What is the dose of tincture of belladonna and what 
indications show that its physiologic effect has been ob= 
tained? 

Dose, 0.5 Cc. (8 minims). Medicinal doses quicken the 
pulse and large doses stimulate respiration. Dryness of the 
mucous membrane and skin and dilatation of the pupil will 
indicate the physiologic effect has been reached. 

For what purposes and effects is strychnia frequently 
used in formulae for cathartics? 

Strychnia stimulates the muscular coat of the intestine, 
increasing peristalsis, and thus acts as a purgative, but it re- 
strains the frequent discharges due to atony of the bowels. 



580 THERAPEUTICS AND MATERIA ME DIG A. 

What effect has pilocarpus on (a) the heart, (b) the 
skin, (c) the salivary glands? 

(a) Pilocarpus acts as a cardiac depressant by stimulation of 
the vagus ends; (b) it causes prompt and profuse perspira- 
tion, and (c) salivation. 

What is the source from which eserine is obtained? 
How and for what purpose is eserine principally used? 

Eserine is one of the alkaloids of physostigma. It is 
used locally in solution of 2 grains to the ounce in the eye 
to contract the pupil and reduce intra-ocular tension. Inter- 
nally it is efficient in constipation due to torpor of the bowel, 
in which condition it is usually combined with belladonna 
and nux vomica. 

Describe the therapeutic uses and the dangers of chloral 
hydrate. How does a toxic dose of chloral hydrate affect 
body temperature? 

Chloral is chiefly used to promote sleep and to check 
spasms. It must be administered with care on account of the 
danger of the patient becoming addicted to the chloral habit. 
It is a distinctly dangerous drug, as it lowers the blood pres- 
sure and body temperature. Cardiac and respiratory weak- 
ness are contra-indications to its use. Toxic doses lower body 
temperature. 

What is the common name of guaiacum? What are the 
therapeutic uses of guaiacum? 

Its common name is lignum vitce. Guaiacum is diaphor- 
etic, expectorant and alterative, also laxative and purgative, 
according to the dose administered. 

What are the therapeutic uses of limonis succus? 

Lemon juice is used as a refrigerant and diuretic mixture 
in fever. For acidity of the stomach and as a common 
remedy in obesity. Locally it is used as an antipyretic, anti- 
pruritic, and as a gargle. It is also used for flavoring pur- 
poses. 



THERAPEUTICS AND MATERIA MEDIC A. 581 

Define anthelmintic and name the remedies of this class. 

Anthelmintics are agents which destroy or expel worms 
inhabiting the intestinal canal. They are classed according 
to the worm against which they are each most efficient. For 
thread worms the principal remedies are quassia, alum, sod- 
ium chloride, lime-water, and the vegetable astringents. For 
round worm, santonin, spigelia, chenopodium. For tape 
worm, filix mas, kamala, kousso, pepo, and granatum. The 
principal vermifuges are the purgatives, castor oil, jalap, 
and scammony. 

What are the therapeutic uses of resorcin? 

Resorcin is employed as an antipyretic and antiseptic. A 
3 per cent, solution gives good results in ulcer of the stom- 
ach, cancer and other morbid conditions. It is also used 
locally as a remedy in skin diseases. 

Name the official preparation and state the therapeutic 
uses of santalum album. 

Oil of santal is official. It is extensively used in chronic 
bronchitis and catarrhal conditions of the genito-urinary 
tract. 

How is collodium made? What are the preparations of 
collodium? 

Collodium is made by dissolving 4 parts of pyroxylin in 75 
parts of ether and 25 parts of alcohol. Preparations are flex- 
ible collodium, styptic collodium and cantharidal collodium. 
Collodium is used as a protective covering for superficial 
burns, ulcers, wounds and slight cuts. Styptic collodium has 
many uses as a hemostatic and protective, while the cantha- 
ridal form is a convenient epispastic. 

Give the common name and the therapeutic uses of 
hematoxylon. 

Log-wood. Log-wood is mildly astringent, its properties 
depending upon the tannin contained in it. It is not irritat- 
ing, and is useful in diarrhea and hemorrhages in young 



582 THERAPEUTICS AND MATERIA MEDICA. 

children. It has been employed as a hemostatic in bleeding 
of the lungs and hemorrhages from the uterus and intestines, 
also as an astringent injection. 

On what physiologic action does the therapeutic use of 
elaterin depend? 

E-laterin is the most powerful of the hydragogue cathar- 
tics, causing profuse watery stools, and when given in large 
doses great prostration and gastro-intestinal irritation, nausea 
and vomiting. 

Name three drugs incompatible with belladonna and two 
incompatible with pilocarpine. 

Tannin and the hydroxides of potassium and sodium are 
incompatible with belladonna, and are also incompatible 
with pilocarpine, as are the salts of the metals generally. 

Give the usual dose of creosote and tell how it is best 
administered. 

It is prescribed in doses of 0.2 Cc. (3 minims), well diluted 
in wine or whiskey. 

Name four official pills and give the principal ingre= 
dients of each. 

Pills with aloes contain purified aloes and powdered soap ; 
pills of asaf etida contain asaf etida and powdered soap ; com- 
pound pills of iron contain myrrh, carbonate of sodium, sul- 
phate of iron and syrup ; compound rhubarb pills contain 
rhubarb, aloes, myrrh and oil of peppermint. 

Define tinctures, extracts and ointments and tell as a 
rule how many drops of a tincture are in a fluid dram. 

Tinctures are alcoholic solutions of medicinal substances, 
and with the exception of tincture of iodine are made from 
non-volatile bodies. Extracts are solid or semi-solid prepa- 
rations obtained by evaporating solutions of vegetable prin- 
ciples. Ointments are soft, fatty mixtures of drugs with a 
basis of lard, petroleum or fixed oils. The number of drops: 



THERAPEUTICS AND MATERIA MEDICA. 583 

to a fluid dram of tinctures varies widely; 110 may be con- 
sidered an average. 

Write a complete prescription containing at least three 
drugs for acute bronchitis in an adult. Use no abbrevia= 
tions. 
Jan. 1, 1903. For Mrs. Watson. 

R . Tinctura? opii camphorata. f^v 

Tincturse nucis vomica? f % ii 

Misturae glvcyrrhizae composite f 3 iv 

M. S. — Teaspoonful every four hours. John Jones, M. D. 

In the treatment of syphilitic node or gumma state 
which should be used, a mercurial or an iodide, and give 
the reason thereof.. 

In the treatment of the tertiary lesions of syphilis the 
iodides and mercury, the so-called mixed treatment, is often 
employed, the object being to get the greatest possible alter- 
ative effect. The appearance of a gumma, especially of the 
nervous system, demands energetic drug treatment. Iodides 
should be given in the largest possible doses, and mercury 
should be administered by inunction. 

Give the reason which would determine the employment 
of a vegetable or a mineral astringent in acute inflam= 
matory conditions. 

Vegetable astringents check secretion and hemorrhages and 
cut short local inflammation. They are practically non-toxic. 

Differentiate the conditions in which opium and hyoscine 
should be used to promote sleep. 

Hyoscine is useful as a hypnotic in children, and in general 
in conditions in which opium is contra-indicated. Children 
are particularly susceptible to opium, and an opium habitue 
would require a different hynotic. 

State when calomel or podophyllum should be given and 
give the reason for the selection. 

Calomel is unirritating, and has also a diuretic effect. 



584 THERAPEUTICS AND MATERIA MEDIC A. 

Podophyllum is more irritating and causes more griping, 
and is to be selected in cases of habitual constipation. 

„ Name the coal=tar products used to reduce temperature. 

Their name is legion. Those in general use are antipyrine, 
phenacetine, acetanilide. 

Describe the alkaloid, strychnia, and give a test for de= 
termining its presence. 

Strychnia is an alkaloid derived from the seed of strychnos 
nux-vomica, a tree of the natural order Loganiacea, growing 
in India and China. Strychnia and its salts dissolve without 
color in concentrated sulphuric acid, but on adding to the 
solution lead peroxide a beautiful blue color results, passing 
into violet, then red, and finally yellow. 

What are the derivatives of cinchona and their doses? 

Cinchona bark contains many natural alkaloids, of which 3 
are official, quinine, cinchonine and cinchonidine. The sul- 
phates of these alkaloids may be administered in doses of 
0.250 Gm. (4 grains). 

Describe four diuretics and give the dose of each. 

Potassium citrate occurs in transparent crystals, is odor- 
less, of cooling saline taste and a neutral reaction, dose 1 Gm. 
(15 grains). Sparteine sulphate, the alkaloid of scoparius, 
occurs in white prismatic crystals of slightly saline and bitter 
taste, dose 0.010 Gm. (y 5 grain). Digitalis (elsewhere de- 
scribed), dose of the infusion, 8 Cc. (2 fTuidraehms) . Calo- 
mel, the mild chloride of mercury, is efficient as a diuretic in 
0.010 Gm. (y 5 grain) doses every hour. 

How does a lethal dose of gelsemium affect the system? 

In toxic doses it produces vertigo, diplopia, drooped eye- 
lids, dilated pupils, labored respiration, slow and feeble 
heart, dropped jaw, staggering gait, extreme muscle weak- 
ness, almost complete anesthesia, and death by asphyxia. 



THERAPEUTICS AND MATERIA MEDIC A. 585 

- Name three indications for the use of opium. 

To relieve pain, to produce sleep, to check excessive secre- 
tion, as in dysentery. 

How does opium act when used as in the last question? 

The principal action of opium is on the nervous system, 
first affecting the cerebral convolutions, which are briefly 
stimulated and soon depressed; next the perceptive and sen- 
sory centers in the higher brain are blunted and the con- 
ductivity of the afferent nerves is impaired. The hypnotic 
action of opium is believed to be due to the lessened activity 
produced by the drug on the nerve cells and the consequently 
lessened demand for blood. Its constipating action is pro- 
duced by stimulation of the inhibitory nerves of the intestine 
through the splanchnic. 

What are the therapeutic uses of the preparations of 
bismuth? 

Locally the insoluble bismuth salts are used in acne rosa- 
cea, stomatitis, coryza, gonorrhea and leucorrhea. The sub- 
nitrate is regarded as of great value in diarrhea and dysen- 
tery, in disordered digestion, vomiting, gastralgia, and gastric 
ulcer. The bismuth nitrate is soluble and toxic, and is not 
generally used. The subcarbonate and the subgallate are used 
in the same class of cases as the subnitrate. 

How would you distinguish quinine from the other cin= 
chona alkaloids? 

The slight solubility of the sulphate of quinine in water 
distinguishes this alkaloid from other cinchona alkaloids. 

Give the adult dose of phosphorus, solution of arsenous 
acid, and tincture of aconite. 

0.0005 Gm. ( T iir grain); 0.2 Cc. (3 minims); 0.6 Cc. 
(10 minims). 

What condition of the eye contra=indicates the use of 
mydriatics? 

All diseases increasing intra-ocular tension. 



586 THERAPEUTICS AND MATERIA MEDIC A. 

Describe the physiologic action of arsenic and name 
three indications for its use. 

In therapeutic dose, with the exception of a slight increase 
in the pulse, arsenic exerts very little influence on the circu- 
lation. In toxic dose it causes the fall of blood-pressure. In 
medicinal dose it is a cerebro-spinal stimulant, but in toxic 
doses it paralyzes the spinal cord, especially the sensory side. 
Small doses increase the appetite and stimulate digestion. 
Toxic doses produce violent gastro-intestinal inflammation. 
In small doses it diminishes and in large doses increases tissue 
waste. In concentrated form it is a powerful irritant and 
eseharotic. It is indicated in anemia, malaria and diabetes. 

For what medicinal purposes is senna used? 

It is used as a laxative in habitual constipation, and in 
larger doses as a cathartic. 

Write a prescription for an ointment containing a rube= 
facient and at least one other constituent. 

Jan. 1, 1903. For John Smith. 

R . Unguenti hydrargyri nitratis £ iv 

Sulphuris. 3 ii 

Creosoti gtt. x 

Adipis f J i 

Fr. unguentum f % i 

S. Rub in well. James Jones, M. D. 

What is the usual physiologic action of an astringent 
administered internally? 

Astringents are agents which produce contraction of muscle 
fiber and condensation of other tissues. They lessen secre- 
tions from mucous membranes. 

What are the medical uses of ammonia? 

Ammonia is employed in medicine when a quickly-acting 
heart and respiratory stimulant is required. It is also used 
as an antacid and a counter-irritant. 

What are the therapeutic uses of lime (calcium)? 

Lime in its unslaked form acts upon the skin as an irri- 



THERAPEUTICS AND MATERIA MEDIC A. 587 

tant and caustic ; if inhaled or swallowed it may produce dan- 
gerous inflammation, followed by ulceration. In weak solu- 
tion it has a sedative and an astringent effect, both locally 
and internally, and acts as an absorbent and antacid. 

For what pathologic conditions may capsicum be used? 

It is an excellent stomachic tonic in atonic dyspepsia and 
in that of chronic alcoholism with tremor and insomnia. In 
acute dipsomania large doses are effective in producing sleep 
and promoting appetite. Locally, capsicum plaster is a mild 
counter-irritant. 

What is the ordinary relative strength of a tincture to 
a fluid extract of the same drug? 

With fluid extracts a cubic centimeter represents the medi- 
cinal powers of 1 gramme of the drug. Tinctures are divided 
into two classes. A uniform strength of 10 per cent, has been 
adopted by the new pharmacopoeia for the tinctures of potent 
drugs. Other tinctures have a strength of 20 per cent. 

Name three agents which are used to promote menstru= 
ation. 

Potassium permanganate, purgatives, as castor oil, and 
ergot. 

How do the preparations of gentian affect the human 
system and in what conditions are they indicated? 

Gentian is used exclusively as a bitter tonic. In atonic 
dyspepsia it increases the appetite and stimulates digestion. 

The dose of medicine given by the mouth being i grain, 
what would be the equivalent dose for hypodermic use and 
what for administration by the rectum? 

For hypodermic injection the dose should be % or % of 
that used by the mouth. By the rectum f of the same. 

How should a case of poisoning with chloral hydrate be 
treated? 

The patient should be aroused by friction, douches, etc., 



588 THERAPEUTICS AND MATERIA ME DIG A. 

but must not be made to walk, as in opium poisoning, on ac- 
count of heart failure. Cardiac and respiratory stimulants 
should be given freely, as ammonia, atropine and strychnine. 
Artificial respiration should be resorted to early, before the 
development of asphyxia. 

In what conditions may cathartics be useful in the treat= 
ment of diarrhea or dysentery? 

Cathartics are useful in the treatment of diarrhea and dys- 
entery, especially early in the course of this condition, in the 
case of diarrhea for the purpose of removing offending mate- 
rial, as indigestible food, discharges, bacteria, etc. 

Define a laxative, a saline purgative, a drastic purgative, 
a hydragogue purgative and a cholagogue purgative, with 
an example of each. 

Laxatives are drugs which excite moderate peristalsis and 
produce soft stools without irritation, as sulphur. Saline 
purgatives include the neutral salts of metals, of the alkalies 
or alkaline earths ; they stimulate the intestinal glands to 
increased secretions and produce a copious evacuation, as 
Epsom salts. A drastic purgative produces violent peri- 
stalsis and watery stools, with much griping pain and tenes- 
mus ; in large doses irritant poisoning results, as jalap. Hy- 
dragogue purgatives are those which remove a large quantity 
of water from the vessels, as elaterium. Cholagogue purga- 
tives stimulate the discharge of bile and produce free purga- 
tion, as podophyllin. 

Would you administer charcoal internally, and if so in 
what dose and for what purpose? 

It may be given with advantage in chronic gastric catarrh, 
cancer, intestinal dyspepsia and diarrhea when flatulence is a 
prominent symptom. Dose is 1 Gm. (15 grains). 

What are the physiologic effects of gelsemium? 

Medicinal doses do not affect the circulation. Toxic doses 
depress the heart. It is a marked depressant to the spinal 



THERAPEUTICS AND MATERIA MEDICA. 589 

cord, and in toxic doses produces paralysis. The drug kills 
by paralyzing the respiratory center. Locally the drug 
causes dilatation of the pupil, probably from paralysis of the 
oculo-motor nerve. 

Describe the therapeutic uses of jalap and state how it 
differs in effect from aloes. 

In moderate dose jalap acts as a hydragogue cathartic, pro- 
ducing copious watery discharges. It is best given in the 
form of compound jalap powder in conditions of general 
dropsy, and should never be employed in simple constipation. 
Aloes is a cholagogue cathartic, stimulating the discharge of 
bile. 

— Name two remedies which are commonly used to pro= 
mote intestinal peristalsis. 

Belladonna and mix vomica. 

What are the therapeutic uses of guaiac? 

Used locally and internally in acute bronchitis ; often pre- 
scribed in chronic rheumatism, gout, sciatica and lumbago. 

^ Name the official bromides. 

The bromides of potassium, sodium, lithium, ammonium, 
strontium and zinc. 

Describe the therapeutic uses of ox=gall. 

It is a tonic, antiseptic and purgative, stimulating the ab- 
sorptive powers of the mucous membrane. It is frequently 
used as a laxative in constipation. 

Where does buckthorn grow? Give the official prepara= 
tion and dose. 

In Europe. Fluidextract of frangula. Dose 1 Cc. (15 
minims) . 

What are the therapeutic uses of gelsemium? 

It is indicated in all conditions of exalted nerve function, 
and contra-indicated whenever the heart is weak. It is espe- 



590 THERAPEUTICS AND MATERIA MEDIC A. 

daily useful in eerebro-spinal meningitis, mania, persistent 
insomnia, neuralgia, dysmenorrhea, incontinence of urine, 
irritation of the bladder, spasmodic coughs and remittent or 
typho-malarial fevers. 

What is the purgative dose of acetate of potassium? 

Two to four drachms. 

What is the common name and therapeutic use of 
plumbi acetatis? 

Sugar of lead. It is a component of the mixture of lead 
water and laudanum, which is employed in bruises and in- 
flammatory swellings where the skin is not broken. It is 
used in solution as a lotion in skin diseases and pruritus, and 
is employed as an astringent in diarrhea. 

How do official waters, e. g. aqua camphorae, differ 
from solutions, e. g, liquor calcis? 

Waters are aqueous solutions of volatile substances ; liquors 
are all aqueous solutions of non-volatile substances. 

How do potassium acetate and potassium bitartrate 
compare as diuretics and purgatives? 

The acetate is the more certain diuretic; the bitartrate is 
the more active cathartic. 

Give the common name and the official preparations of 
prunus Virginiana. 

Wild cherry. The official preparations are the fluid ex- 
tract, infusion and syrup. 

On what chemical change in the intestinal tract does 
the purgative action of castor oil depend? 

The oil is decomposed by the pancreatic juice, setting free 
ricinoleic acid, which produces purgation by a mildly irritant 
action on the bowels, stimulating the glands and muscular 
-coat, but not the liver. 

What are the therapeutic uses of acetic acid? 

Used internally as a mild refrigerant and antiscorbutic, 



THERAPEUTICS AND MATERIA MEDIC A. 591 

and as an antidote in poisoning by alkalies, such as ammonia. 
Locally it is used to check hemorrhages and as an escharotic. 

What is the proportion of mercury in blue pill? What 
is the dose of blue pill? 

It contains 33 per cent, of mercury. Dose 1 to 20 grains. 

What effect has benzoin on the urine? Name the prep= 
arations of benzoin. 

It renders the urine acid and increases its quantity. The 
preparations of benzoin are adeps benzoinatus, tinctura ben- 
zoini, tinct. benzoini composita, acidum benzoicum. ammonii 
benzoas. lithii benzoas, sodii benzoas. 

What are the alkaloids of pilocarpus and how do they 
compare in physiologic effect? 

The alkalies of pilocarpus are pilocarpine, jaborine, antag- 
onistic to pilocarpine in action; pilocarpidine, analogous to 
pilocarpine, and jaboridine, which is analogous to jaborine. 

What is the source of camphor and what is the dose of 
spiritus camphorae? 

Camphor is a stearopten obtained from the cinnamomum 
camphora, a tree of the natural order Lauracece (indigenous 
to China and Japan), purified by sublimation. Dose of the 
spirit 1 Cc. (15 minims). 

Give the common name and the therapeutic uses of 
potassium bitartrate. 

Cream of tartar. It is an agreeable laxative, and also is 
used as a diuretic in infusion of juniper in general cardiac 
dropsy. 

Give the source and preparations of gum arabic. 

Acacia, gum arabic, is a gummy exudation of Acacia Sen- 
egal, a small tree native in Africa. Its preparations are the 
syrups and mucilage. It enters also into the composition of 
official troches, etc. 



592 THERAPEUTICS AND MATERIA MEDIC A. 

Mention the therapeutic uses of nitric acid. 

It is locally a powerful escharotie, and internally in dilute 
form in bilious affections. It lessens phosphatic deposits and 
acts as an astringent to the system, diminishing expectora- 
tion in bronchorrhea and phthisis. 

Give the physiological action and the therapeutic uses of 
sarsaparilla. 

It is doubtful if it possesses any physiologic action. Some, 
however, claim it to be diurectic, diaphoretic, tonic and alter- 
ative. Its chief value is as an excipient for administering 
potassium iodide and mercuric chloride in syphilis. 

Describe and give the indications for the uses of cardiac 
sedatives, with an example. 

Cardiac sedatives are drugs Which are used to decrease the 
activity of the circulation. The indications for their use are 
increased arterial excitement, sthenic fevers and severe local 
inflammation. Aconite is an example of such a drug. It 
reduces very markedly the rate of the pulse and the arterial 
pressure. 

Describe the physiologic action of antipyrine in medicinal 
doses on the circulation and temperature. 

After the ingestion of a full medicinal dose there is a stim- 
ulant stage, in which the heart's activity is increased; this is 
soon followed by profuse sweating, coolness of the surface, 
slowed pulse, considerable depression, and if fever be present 
by lowered temperature. In health it has very slight anti- 
pyretic effect. It raises the arterial tension and blood pres- 
sure. 

How do digitalis and belladonna act in increasing blood 
pressure? 

Digitalis increases blood pressure by its powerful stimu- 
lating effect on the heart by contraction of the arterioles, 
resulting indirectly from stimulation of the vasomotor center, 
and directly from the action of the drug on the vessel walL 



THERAPEUTICS AND MATERIA MEDICA. 593 

The increased blood-pressure produced by belladonna is due 
to stimulation of the vasomotor centers and the heart itself. 

Name a vasomotor stimulant, a vasomotor depressant 
and describe the physiologic action of each. 

Belladonna is a vasomotor stimulant; it quickens the pulse 
and raises arterial pressure. The increased blood-pressure 
is due to stimulation of the vasomotor center and the heart 
itself. Toxic doses paralyze the heart; large doses stimulate 
the respiratory center; toxic doses paralyze it; large doses 
stimulate the brain and spinal cord and act as a depressant 
to the motor and sensory nerves; it lessens nearly all of the 
secretions except that of the kidney; it dilates the pupil by 
paralyzing the peripheral ends of the oculo-motor nerves 
and by stimulating the ends of the sympathetic. Veratrum 
viride is a vasomotor depressant; it lessens in a marked de- 
gree the force and rate of the cardiac pulsation ; the lowered 
arterial tension results from depression of the vasomotor cen- 
ter and of the heart itself; the slowing of the pulse from 
stimulation of the inhibitory nerves of the heart and from 
weakening of the cardiac muscles. Large doses depress the 
respiratory center, the spinal cord and peripheral nerves and 
muscles. 

Give the theory of the alkaline treatment of rheuma= 
tism. 

The alkaline treatment of rheumatism by the administra- 
tion of potassium acetate, citrate, etc., was in general use 
before the introduction of the salicylates. Wood states that 
the alkalies do good in rheumatism by lowering arterial ac- 
tion, by favoring oxidation and elimination of partially effete 
products, and by neutralizing excessive acidity. 

What is incompatibility in medicine, and what are the 
different kinds of incompatibles? Give an example of 
each. 

Incompatibility in medicine signifies that a combination is 

38 



594 THERAPEUTICS AND MATERIA MEDICA. 

not suitable for administration. Incompatibility may be 
chemical, pharmaceutical and therapeutic, according as the 
prescribed combination results in chemical decomposition, 
physical disassociation or antagonistic action. An example 
of chemical incompatibility is seen in the prescribing of qui- 
nine sulphate with potassium acetate, resulting in a volu- 
minous precipitate of quinine acetate. An instance of phar- 
maceutical incompatibility is the addition of an acid to a 
quinine and liquorice mixture, resulting in precipitation of 
the glycyrrhizin, relied on to cover the taste of the quinine. 
Therapeutic incompatibility arises when two agents mixed to- 
gether oppose each other in their action, for instance bella- 
donna and physostigma. 

Describe the physiologic action of salicylic acid. 

Salicylic acid is a powerful antipyretic and antiseptic. In 
small doses it stimulates the stomach, heart and respiration, 
but moderate quantities derange the stomach, causing nausea 
and vomiting, while large doses depress the heart's action 
and the respiration, lower the arterial tension, relax the ves- 
sels and produce free perspiration. 

Name the therapeutic uses of apomorphia and state how 
codeia differs in its physiologic action from morphia. 

Apomorphia is a valuable emetic and a useful expectorant 
in the dry stage of acute bronchitis, and in chronic bronchitis 
when the expectoration is viscid and scanty. While codeia 
possesses but feeble hypnotic powers, it exerts a sedative influ- 
ence similar to morphine ; it is at times much better borne by 
patients than morphine, but is regarded as less reliable. 

^ Enumerate the symptoms arising from a toxic dose of 
digitalis. 

Digitalis poisoning is characterized by obstinate vomiting, 
diarrhea, headache, severe pain in the back and limbs and a 
very slow, full pulse, which, when the patient sits up, may 
become rapid and feeble. Later, even in recumbency, the 
pulse becomes rapid, thready and irregular, the surface cold. 



THERAPEUTICS AND MATERIA MEDIC A. 595 

the urine suppressed and the mind stuporous. Intelligence, 
however, is not lost until shortly before death. Occasionally 
convulsions develop during the last stage. 

What are the therapeutic uses of tartar emetic? 

It is employed as an emetic, diaphoretic, sedative, expecto- 
rant, cardiac depressant and counter-irritant. 

Describe cantharis and name three official preparations. 

Cantharis is the dried body of the beetle, Cantharis vesica- 
toria, found chiefly in the south of Europe. The active prin- 
ciple is cantharidin. Ceratum cantharidis, collodium can- 
tharidatum, tinctura cantharidis. 

By what rule would you determine the dose of any medi= 
cine for a child? 

Young's rule will be found the most convenient. Add 12 
to the age and divide by the age, to get the denominator of a 
fraction, the numerator of which is 1 ; thus, for a child 2 
years old, 2 plus 12 divided by 2 equals 7, and the dose is 1-7 
of that for an adult, 

Name ten official preparations of mercury. Name four 
alkaloids of opium. 

Hydrargyrum cum creta, massa hydrargyri, unguentum 
hydrarygri, emplastrum hydrargyri, hydrargyri chloridum 
mite, hydrargyrum ammoniatum, unguentum hydrargyri 
ammoniati, hydrargyri oxidum flavum, unguentum hydrar- 
gyri oxidi flavi, hydrargyri oxidum rubrum. Four alka- 
loids of opium are morphine, codeine, thebaine and narcotine. 

Give the source and dose of picrotoxin, creosote and pix 
liquida. 

Picrotoxin is a neutral principle derived from cocculus 
indicus, dose 1-100 to 1-20 grain. Creosote is a product ob- 
tained from distillation of wood-tar, dose 0.2 Cc. (3 minims). 
Pix liquida, tar, is an oleoresin obtained from the destructive 
distillation of certain species of Pinus ; the dose is 0.500 G-m. 
<7% grains). 



596 THERAPEUTICS AND MATERIA MED1CA. 

What are the principal therapeutic uses of the prepara= 
tions of mercury? 

The plaster of mercury is used as an absorbent and counter- 
irritant over chronic inflammatory swelling, glandular en- 
largements, syphilitic nodes, etc. Mercurial ointment and 
the oleate of mercury are used for the same purposes as the 
plaster; they are also extensively employed in the treatment 
of syphilis by inunction. Blue mass is used as a cholagogue, 
laxative and diuretic. Ammoniated mercury is used exter- 
nally as a stimulant or parasiticide. The chloride of mer- 
cury is> an antiseptic, anti-parasitic, anti-syphilitic ab- 
sorbent, and tonic. The mild chloride, calomel, is used 
internally as an anti-syphilitic, as a laxative, as a gastric 
sedative, a cholagogue and a diuretic, and externally as a 
stimulant and desiccant, Mercury and chalk is used in the 
same class of cases as calomel. The yellow iodide is fre- 
quently used as a substitute for the chloride, as is the red 
iodide. The nitrate is used externally as a powerful caustic. 
The oxide is used externally for its stimulant and alterative 
effect. The yellow sulphate, turpeth mineral, is sometimes 
employed as a stimulating emetic for children, but it is dis- 
tinctly poisonous. 
- State the contraindications to the use of quinine. 

It is contra-indicated in acute inflammatory affections of 
the brain, eyes and ears. 

In what form would you prescribe eucalyptus and in 
what doses? Whence is eucalyptus obtained. 

Eucalyptus is derived from the leaves of the tree Euca- 
lyptus globulus, a native of Australia. It may be prescribed 
in doses of 2 Cc. (30 minims) of the fluid extract or in doses, 
of 0.5 Cc. (8 minims) of the oil in elastic capsules or emulsion. 

In what strength would you use solutions of nitrate of 
silver, borax, permanganate of potash, bichloride of mer= 
cury and creolin for injection into the bladder? 

Silver nitrate, 1 grain in 4 ounces of water ; borax, 10 grains; 



THERAPEUTICS AND MATERIA MEDIC A. 597 

to the ounce; permanganate of potassium, 20 grains to the 
pint ; bichloride of mercury, 1 to 3000 ; creolin, y 2 to 1 per- 
cent. 

Name six drugs containing large quantities of tannic 
acid. 

Galla, catechu, hamamelis, kino, granatum, hematoxylin. 

Name four drugs incompatible with iodide of potassium, 
two with atropine and one with antipyrine. 

Potassium iodide decomposes most of the metallic salts. 
The following four drugs are examples of this incompati- 
bility : Sulphate of quinine, sulphate of iron, acetate of lead, 
oxide of zinc. Physostigmine and aconite are incompatible 
with atropine. Tannic acid is incompatible with antipyrine. 

Give the physiologic action of ergot and mention its 
therapeutic uses. 

Ergot is a motor excitant and a vascular contractor. It is 
also hemostatic and anhydrotic, emmenagogue and oxytocic. 
It increases the functional activity of the spinal cord, it stim- 
ulates the vasomotor center, raises the blood-pressure, pro- 
duces contraction of unstriped muscle fiber, reduces the cali- 
ber of the arterioles, depresses the motor ganglia of the heart 
and causes a slower and weaker pulsation. 

Ergot is used to promote uterine contractions in labor, in 
amenorrhea due to plethora and in the atonic form of sper- 
matorrhea. It is useful in catarrhal inflammations of the 
mucous membranes generally. It is an excellent remedy in 
chronic diarrhea and dysentery, in hemorrhages of arterial 
type, in headache and migraine of congestive form, in mye- 
litis and tabes and chronic nervous diseases. It is also used 
locally in hemorrhages. 

Name four drugs used in the treatment of bronchorrhea 
and explain their action. 

Eucalyptus for its expectorant effect. Lead acetate for its 
astringent effect to restrict secretions. Quinine and arsenic 
as valuable tonics and restoratives. 



598 THERAPEUTICS AND MATERIA MEDIC A. 

What is the physiologic action of rhubarb in dose of 1 
to 5 grains? In dose of 30 to 60 grains? 

In small doses its action is that of a gastric tonic and an 
intestinal astringent. In larger doses its cathartic action 
prevails, producing in 6 to 8 hours copious yellow stools with 
some griping and considerable hepatic stimulation. 

For what purposes is diaphoresis produced? Name 
three diaphoretics. 

Diaphoretics are employed in medicine to fulfil the follow- 
ing indications: (1) to arrest forming diseases of not very 
severe type, as in general cold and suppressed menstruation;. 
(2) to favor absorption, as in dropsy; (3) to aid in the sub- 
sidence of diseases which naturally pass off in a sweat, as 
malaria; (4) to eliminate noxious materials from the blood. 
Three excellent diaphoretics are pilocarpus, spirit of nitrous 
ether and Dover's powder. 

What is the source and what are the therapeutic uses of 
picrotoxin? 

Picrotoxin is a poisonous neutral principle obtained from 
the seeds of cocculus indicus, used in the night sweats of 
phthisis and in the form of an ointment as an anti-parasitic. 

Give the chemical name and the dose of (a) Epsom salts, 
(b) Rochelle salts, (c) Glauber's salts. 

(a) Magnesium sulphate, dose 16 Gm. (240 grains) ; (b) 
potassium and sodium tartrate, dose 8 Gm. (120 grains) ; (c) 
sodium sulphate, dose .16 Gm. (240 grains). 

Describe hypodermoclysis and state the circumstances 
under which it is practiced as a therapeutic measure. 

Hypodermoclysis is the introduction into the subcutaneous 
tissue of fluids in large quantity. It is indicated to replace 
the fluid lost through excessive purging or hemorrhage. It 
may also be used to wash from the body certain impurities 
circulating in the blood and lymph ; in other instances it may 
be used to supply the body with liquid when the stomach will 



THERAPEUTICS AND MATERIA MEDIC A. 599 

not permit drinks to be swallowed, as in gastric ulcer or 
abdominal operations. Normal saline solution is used for 
such injections. The sterilized liquid is placed in a proper 
vessel which is absolutely aseptic, and to which air gains ac- 
cess only by means of a glass tube filled with sterilized cotton ; 
from the lower part of the vessel a rubber tube leads, to 
which is attached a canula carefully sterilized. The skin 
over the place where the liquid is to enter is to be rendered 
sterile. The trocar is then inserted into the subcutaneous 
tissue of the abdomen or thigh and the solution allowed to flow 
at the rate of 1 dram to each pound of body weight in 15 
minutes. The pressure is obtained by raising the container a 
few feet. 

Define galactagogue and sialagogue and give an example 
of each. 

A galactagogue is an agent which increases the secretion of 
milk, example pilocarpus. A sialagogue increases the secre- 
tion and flow of saliva and buccal mucus, example mercury. 

By what process and from what source is sugar of milk 
principally obtained? 

It is a crystalline sugar obtained from the whey of cows' 
milk by evaporation and recrystallization. 

State the source and give the uses of saccharin. 

It is derived from coal tar. It is about 500 times sweeter 
than sugar and is used as a substitute for sugar in the food of 
diabetics and subjects of liver disease and corpulence. 

Describe the preparation of lime water. Give the offi= 
rial name and the adult dose. 

Liquor calcis may be given to an adult in average doses of 
16 Cc. (4 fluidrachms). It may be prepared by pouring 2 
quarts of hot water over fresh unslaked lime the size of a 
walnut ; stir till slaked, let it stand until clear and bottle. 



600 THERAPEUTICS AND MATERIA ME DIG A. 

Give the source, the physiologic action and the thera= 
peutic uses of oleum ricini. 

Castor oil is a fixed oil expressed from the seeds of ricinus 
communis. It acts as a mild, but rather slow purgative, pro- 
ducing without irritation copious semi-liquid stools. It does 
not increase the flow of bile nor to a great extent the secre- 
tions of the intestinal canal, but excites catharsis by stimu- 
lating the muscular coat of the bowel. It is useful in acute 
inflammatory affection of the bowel and as a laxative in preg- 
nancy, anal fissure and painful hemorrhoids. 

What are the medicinal uses of potassium chlorate? 

It is an excellent local application in inflammatory condi- 
tions of the mouth and throat, being valuable in the various 
forms of stomatitis, in acute pharyngitis, in diphtheria and 
scarlet fever. 

How should poisoning by coal gas be treated? 

Antidotes, chlorine water as a spray, inhaled. Antago- 
nists, oxygen by inhalation 4 or 5 quarts. Ammonia vapor 
inhaled. Galvanism, by interrupted current to extremities. 
Artificial respiration, to be maintained steadily for hours. 
Rhythmic traction of the tongue. Fresh air in plenty; open 
all doors and windows. Coffee, black, a pint as enema. 
Venesection may be of service. Douche, alternately cold and 
warm, to head and chest. Horizontal position, clothing re- 
moved. Alcohol moderately by mouth or rectum. Catheter 
may be required in prolonged cases. Subsequently a warm 
bed, heat applied to the body and limbs, open windows, perfect 
quiet, Condy's fluid about the room, stimulants sparingly, 
cold acid drinks freely. 

Write a prescription for a cough mixture containing 
muriate of ammonia and an opiate, giving adult dose. 
Jan. 1, 1903. For Joseph Wilson. 

R . Amraonii chloridi. 3 V 

Tr. opii camph f 3 v 

Syr. pruni virg f ^ iv 

M. S. — f 3 i every four hours. 

Joseph Jones, M. D. 



THERAPEUTICS AND MATERIA MEDIC A. 601 

What are the therapeutic uses of podophyllin? 

It is an excellent laxative in constipation associated with 
hepatic congestion. It tends to produce griping and is usu- 
ally given with small doses of belladonna or hyoscyanms. 

What is the dose of Fowler's solution and what precau= 
tions should be observed in its administration? 

The dose is 0.2 Cc. (3 minims). Potter advises that full 
doses of the solution should be taken at first, and always im- 
mediately after food; the dose should then be gradually re- 
duced. Susceptible persons often tolerate it better if a few 
drops of laudanum are administered with each dose. Swell- 
ing beneath the eyes is an indication of the physiologic limit 
for the employment of the drug. 

From what part of the colchicum plant is the active 
principle obtained? 

From the corm and seed. 

What injurious effect is liable to follow the prolonged 
internal use of the preparations of silver? 

Argyria. The first sign of this condition is a slate-colored 
line along the margin of the gum with some inflammatory 
swelling. Subsequently grayish patches appear on various 
parts of the skin and mucous membrane and gradually extend 
over the whole body. As a rule, argyria does not produce 
serious effects on the health of the subject. The pigmenta- 
tion is due to a deposit of silver in the connective tissues. In 
the skin it is found in the corium. The discolorization is per- 
manent. 

- Name a vesicant derived from (a) the animal kingdom, 
(b) the vegetable kingdom, (c) the mineral kingdom. 

(a) Cantharides, (b) mustard, (c) iodine. 



602 THERAPEUTICS AND MATERIA MEDIC A. 

Write a prescription for diarrhea containing an alkali 
and an astringent suitable for a child of ten years. 

Jan. 1,1903. Walter. 

B . Sodii bicarbonatis 311 

Bismuthis subcarbonatis 3 ii 

Tragacanthse 3 i 

Spts. chloroformi f 3 i 

Aquae cinnamomi f J iv 

M. S. — Teaspoonful every four hours. 

Joseph Jones, M. D. 

What is the vulgar name for veratrum viride? What is 
its active principle and the dose of the principle? 

American hellebore. It contains several active principles, 
of which the most important is jervine. The dose of the 
tincture is 1 Cc. ( 15 minims) . 

Name three drugs which are administered internally to 
arrest bleeding. 

Ergot, gallic acid and hematoxylon. 

What are the therapeutic uses of magnesia? 

It is used as an antacid and laxative in acidity, sick head- 
ache, colic, etc., and as an antidote in poisoning by acids, 
arsenic, phosphorus and the mercuric and copper salts. 

Mention the medical uses of the oil of turpentine. 

The oil of turpentine is employed externally as a rubefa- 
cient and counter-irritant in many conditions causing pain 
and inflammation. The liniment is in constant use for sprain, 
neuralgia and other slight local affections. Internally it is 
best employed in ulceration and hemorrhage of the intestines, 
and in passive hemorrhage from other organs. It is also used 
as an anthelmintic against tape-worm, and is of value in flatu- 
lent colic. It is employed in chronic bronchitis and chronic 
inflammations of the mucous membranes generally. 

For what are the preparations of juniper used in medi= 
cines? 

Juniper is a stomachic tonic, diaphoretic, diuretic and 



THERAPEUTICS AND MATERIA MEDIC A. 603 

aphrodisiac. The oil acts therapeutically like the oil of tur- 
pentine, and may be used in chronic cystitis, etc., but is 
contra-indicated where acute inflammations of the kidney 
exist. 

How should a case of poisoning with atropine be treated? 

Tannic acid should be given freely and the stomach emptied 
by an emetic or the stomach-pump. Collapse must be met by 
the use of heart stimulants, such as ammonia, alcohol and 
nitroglycerin. 

What is the vulgar name of physostigma? 

Calabar bean. 

What are the therapeutic uses of the preparations of 
zinc? 

The acetate is used as an astringent application in conjunc- 
tivitis and subacute gonorrhea. The precipitated zinc car- 
bonate is used as a sedative astringent in acute inflammatory 
affections of the skin, such as erythema and eczema, The 
chloride is used as an astringent antiseptic and caustic. It 
is also used in chronic inflammation of the mucous mem- 
branes. The oxide is employed in the form of an ointment 
or powder externally as a mild astringent and sedative in 
burns, acute ulcers, etc. Internally it is of doubtful value 
as an anti-spasmodic and anti-hydrotic. The phosphide of 
zinc is employed in the same class of cases in which phos- 
phorus is indicated. The sulphate of zinc is employed locally 
as an astringent, and internally is used in chronic dysentery 
and diarrhea, as well as an emetic in large doses in narcotic 
poisoning. 

Name three official preparations of camphor. 

Aqua camphoras, linimentum camphora? and spiritus cam- 
phoras. 



604 THERAPEUTICS AND MATERIA MEDIC A. 

Write a prescription containing some preparation of 
iron in a delectable form. 

Jan. 1, 1903. For Wm. Jones. 

U . Tincturse ferri chloridi. f 3 ii 

Acidi phosphorici diluti £3 iii 

Spiritus limonis f 3 i 

Syrupi. f J iiss 

Aquam ad f J vi 

M. S. — Tablespoonful after meals. 

John Smith, M. D. 

What preparations of copper are used in medicine and 
for what purposes? 

The only official salt of copper is the sulphate ; it is useful 
in phosphorus poisoning both as an emetic and a chemical 
antidote. The application of the solid crystal is often useful 
for its astringent and stimulating qualities. It is also useful 
in gonorrhea in the subacute stage. Internally it is some- 
times employed in chronic diarrhea. 

What are the therapeutic uses of borax? 

Borax is sodium borate, which is a powerful antiseptic and 
disinfectant. It has been used internally in amenorrhea, 
dysmenorrhea and puerperal convulsions and epilepsy. In 
the form of a wash it is of value as an anti-pruritic. 

With what remedies should spasmodic croup be treated? 
Name three suitable ones. 

With emetics, as ipecac, and with anti-spasmodics, such as 
the bromides. Lobelia is a useful remedy. 

Describe the medicinal uses of hydrocyanic acid. 

Hydrocyanic acid is used solely to allay irritation of the 
peripheral nerves. Thus it is employed internally for the 
cough of phthisis and chronic bronchitis, for gastralgia in 
obstinate vomiting, and externally to subdue the itching in 
pruritis, eczema and urticaria. 



THERAPEUTICS AND MATERIA MEDICA. 605 

Mention the conditions which affect the dosage of medi= 
cines. 

The age of the patient, the personal idiosyncrasy, the con- 
dition of the heart, kidneys, nervous and respiratory system. 

What class of acids would you use to acidify alkaline 
urine? 

Benzoic acid and its derivatives, as benzoate of sodium and 
ammonium. 

What is the dose of phenacetine as an antipyretic? 

Dose 0.500 Gm. (714 grains) every 4 to 6 hours. 
N What is the composition of the so=called green soap? 

Green soap is prepared from potassa and linseed oil. 

Where does arnica grow most abundantly? What part 
of the plant is used in medicine? 

In the mountains of northern Europe and Siberia. Both 
the flowers and the roots are official. 

What is glycerin and what are its therapeutic uses? 

Glycerin is obtained by the decomposition of vegetable or 
animal fats or fixed oils. It is a triatomic alcohol, existing 
in fats and fixed oils in combination with the fatty acids. 
Externally it is used in various forms as an emollient. In 
the various acute inflammations of the fauces, it makes an 
excellent vehicle for carrying other drugs. Being hygro- 
scopic, it not only depletes the turgid vessels, but it spreads 
the medicant over the entire surface. It is especially useful 
in tampons in such conditions as uterine congestion. It may 
be employed in suppository in obstinate constipation. It is 
sometimes used as a substitute for sugar in diabetes. 

How many grains of the hydrochloride of cocaine are 
contained in one ounce of a ten per cent, solution? 

Forty-eight grains. 

What is the dose of the fluid extract of senna? 

Dose, 2 Cc. (30 minims). 



606 THERAPEUTICS AND MATERIA MED1CA. 

What injury may result from large doses or long con= 
tinued use of potassium chlorate? 

The chlorate is distinctly irritant to the kidneys. An in- 
flammation of these organs may follow its use. 

Give the habitat of squills and state which of its prep= 
arations are used in medicine. 

It is native to southern Europe. The preparations are 
vinegar of squills, fluid extract, syrup, compound syrup and 
tincture. 

Describe the therapeutic uses of olive oil and state 
where it is principally produced. 

It is produced principally in southern Europe, California 
and Australia. Externally used it is a good protective from 
the air, and if rubbed into the skin is absorbed by the lym- 
phatics and is directly nutritive. Internally it is a food and 
a mild laxative, and in quantity protects the mucous mem- 
branes against the action of poisonous substances. 

How should phosphorus poisoning be treated? 

Immediate full dose of sulphate of copper, which is an 
emetic as well as a chemical antidote. Potassium perman- 
ganate and French oil of turpentine are also of value. 

What is the dose of oleum erigerontis? 

Dose 1 Cc. (15 minims). 

Write the following prescription in the metric system: 

R . Ammonii bromidi. 2 drams 

Sp. ammonise aromat 1 dram 

Aquse • 4 ounces 

Misce. 

B . Ammonii bromidi 8 

Sp. ammonia? aromat 4 

Aquas 120 



Misce. 



What is the dose of oleum sabinae? 

Dose 0.05 Cc. (1 minim). 



THERAPEUTICS AND MATERIA MEDIC A. 607 

^ What medicine would you give to promote bone growth? 

One of the preparations of lime, as lime water, or the 
carbonate or phosphate. 

What is the alkaloid of pomegranate and for what is it 
used? 

Pellatierine; it is a teniafuge. 

By what other name is saltpetre known? 

Potassium nitrate and nitre. 

- In what dose may sulphonal be administered to an adult 
to produce a soporific effect? 

It may be given in average dose of 1 Gm. (15 grains), best 
in hot milk about 2 hours before retiring. 

To what chemical change does sulphur ointment owe its 
efficiency as a parasiticide? 

Sulphur ointment contains an alkaline ingredient and de- 
velops sulphides which are powerful anti-parasitics. 

What are the uses of lactic acid in medical practice and 
what pathologic conditions may its administration pro= 
duce? 

It is employed as a mild caustic, a digestant and intestinal 
antiseptic. It is a valuable local remedy in laryngeal tuber- 
culosis, and internally in cholera, typhoid fever, simple diar- 
rhea and the diarrhea of infants. It is supposed to cause 
acute rheumatism when in excess and free in the blood. 

Write the following prescription in the metric system: 

R . Morphinae sulphatis. grains 6 

Sodii boratis drams 4 

Aquse camphors? fl. ounces 6 

R . Morphinse sulphatis 14 

Sodii boratis 16 

Aquse camphorse 180] 

What is the effect of full doses of opium on respiration 



608 THERAPEUTICS AND MATERIA MEDICA. 

and to what extent may this effect be safely carried in 
treatment? 

In full dose there is irregular and slow respiration. It 
should not be used when there is profuse expectoration, as 
the lowering of excitability of the respiratory center which it 
produces would be dangerous in such a case. Morphine is 
combined with atropine to overcome the effect of the former 
on the circulation. It should be avoided in all organic dis- 
eases of the lungs associated with weak respiration. 

Where is colocynth obtained and for what is it used? 

Colocynth is the fruit of citrullus colocynthis deprived 
of its rind. The plant is a native of Spain and Asiatic 
Turkey. It is classed among the tonic, astringent and resin- 
bearing purgatives. In moderate doses it increases peristal- 
sis and the intestinal glandular secretion; watery evacuations 
with griping pain. 

What is the comparative action of strychnine and a!co= 
ho! on the arterioles? 

Strychnine raises the arterial pressure by stimulating the 
vasomotor center in the medulla. Alcohol inhibits the vaso- 
motor system, causing dilatation of all the vessels of the body, 
especially those of the periphery. The blood pressure is 
raised, however, owing to the great increase of cardiac action, 
which overcomes the results of the arteriole dilatation. 

How may carboHc acid poisoning be produced and how 

treated? 

Carbolic acid poisoning may be induced by the local use, 
especially of weak solutions, of the acid, as well as by the 
internal ingestion of carbolic acid or its derivatives. The 
treatment of the poisoning consists of the administration of 
the antidote, which is a soluble sulphate, as sulphate of 
sodium ; this unites with the acid, forming an insoluble sulpho- 
carbolate. Evacuation of the stomach, the application of 
external heat and stimulants and the use of mucilaginous 
drinks are indicated. 



THERAPEUTICS AND MATERIA MEDIC A. 609 

Would you write for potassium chlorate and tannin in 
the same prescription? Give reason for your answer. 

No. There would be danger of explosion. 
Mention the therapeutic uses of gamboge. 

Gamboge is an irritant purgative, decidedly diaphoretic ; 
its catharsis is accompanied by vomiting and colic. It has 
no cholagogue action. Its use, for the most part, is limited 
to the compound cathartic pill, of which it is a constituent. 

Where is kousso obtained? What preparation is used 
and for what purpose? 

Kousso is a native of Abyssinia ; it is used in the form of the 
fluid extract as an anthelmintic against tape-worm. 

What remedies should be used for hemorrhages from 
mucous surfaces? 

The astringents and vaso-contractors ; the extract of supra- 
renal gland is probably of greatest value; ergot, gallic acid 
and opium are employed internally. 

On what theory can the use of salol in diarrheal diseases 
be advocated? 

In the intestine it is separated into carbolic and salicylic 
acids and acts as an antiseptic. It is free from irritating 
properties. 

For what is copaiba used in medical practice? 

Copaiba is used in subacute or chronic inflammations of the 
genito-urinary tract. 

Name a drug commonly used which affects the color of 
the stools without altering the constituency, and explain 
the cause. 

The organic salts of iron blacken the feces by conversion 
into the sulphide. 

Describe the three stages of chloroform narcosis. 

1st stage : This stage is very short and the symptoms are 
very similar to those of alcoholic intoxication. Consciousness 
39 



610 THERAPEUTICS AND MATERIA MEDIC A. 

is not lost but the sensibility is generally dulled. Pupils of 
eyes dilated. 

2d stage : This is the stage of anesthesia, consciousness and 
sensibility are abolished, the muscles are relaxed and the pa- 
tient is quiet. The pulse is generally normal in frequency, 
but somewhat weakened. Pupils of eyes ^contracted. 

3d stage : This stage is one of profound narcosis with ster- 
torous breathing, intense muscular relaxation, abolition of the 
ordinary reflexes and fall of bodily temperature. Pulse is 
weak and rapid. Pupils of eyes dilated. 

Describe the three stages of anesthesia under ether. 

1st stage : Burning in the fauces, feeling of strangulation, 
sense of exhilaration, lightness in the head with a buzzing or 
roaring in the ears. These symptoms are soon followed by a 
semi-unconsciousness with visions and illusions. Pupils of 
eyes dilated. 

2d stage: This stage begins with a complete loss of con- 
sciousness. Muscular rigidity soon passes off and the patient 
is quiet. Respiration is slow and regular. Pupils of eyes 
contracted. 

3d stage : Same as the third stage under chloroform narcosis. 

Give the contraindications to the use of anesthetics. 

Organic brain disease, including tumors, atheromatous con- 
ditions of the blood vessels, organic affections of the heart, 
lungs and kidneys (Wood) . Some authorities add diabetes 
mellitus, chronic alcoholism and enlarged tonsils. 

Why is the use of ether as an anesthetic contra=indicated 
in diseases of the lungs and kidneys? 

Because it is eliminated by the lungs and kidneys, and on 
account of its irritating qualities it would aggravate the 
diseased condition. 

What is meant by cataphoric application of a remedy? 

By cataphoric application of a remedy is meant the in- 
filtrating of the tissue with some drug by electrical osmosis. 



THERAPEUTICS AND MATERIA MEDIC A. 611 

Give the indications for the use in producing sleep of 

(a) morphine, (b) chloral, (c) potassium bromide. 

(a) Morphine is used when sleeplessness is due to pain. 

(b) Chloral is indicated when sleeplessness is due to mental 
overwork and where a more powerful hypnotic than potassium 
bromide is required. If the heart or stomach are in bad con- 
dition it should not be given, (c) Potassium bromide is given 
when insomnia is caused by cerebral excitement, nervous ex- 
citement (especially when connected with the genital function) 
and motor activity. According to "Wood it is contra-indicated 
by an excessive irritability of the gastro-intestinal mucous 
membrane and great exhaustion. 

(a) What systemic conditions contra=indicate the use of 
nitrous oxide gas? (b) State why. 

(a) Atheromatous vessels, fatty heart and pulmonary em- 
physema. (Burchard). (b) Nitrous oxide gas increases blood 
pressure and in atheromatous degeneration of the arteries this 
may result in rupture of these vessels and if in the brain, 
apoplexy or early death may ensue. 

In fatty heart the muscles are weakened, and on account of 
the increased resistance in the blood-vessels there may be 
sudden dilatation of this organ. 

In pulmonary emphysema the danger is in the engorgement 
of the blood vessels of the lungs which causes an increased re- 
sistance to the right heart, which may result in the suddejL 
dilatation of this organ, or there may be pulmonary edema 
-or hemorrhage. 

(a) What are topical remedies? (b) Mention two 
classes, (c) Give two examples of each. 

(a) Topical remedies are those which are applied locally. 
(b) Plasters and liniments, (c) Belladonna plaster and cap- 
sicum plaster — turpentine liniment and chloroform liniment. 

Give the signs of danger in chloroform anesthesia and 
tell what should be done. 

Lividity of the face, irregular or stertorous breathing 



612 THERAPEUTICS AND MATERIA MEDIC A. 

or feebleness of the pulse. Withdraw the anesthetic, lower 
the head, use artificial respiration and give a hypodermic 
injection of strychnine, digitalis, or atropine. 

When is chloroform preferred to ether as an anesthetic? 

In acute inflammation of the bronchi or lungs, aneurism, 
atheroma and nephritis. 

Name the accidents that may happen during the admin- 
istration of ether, and give the treatment in each case. 

In the early part of the administration of ether we may 
have failure of respiration, which is due to reflex spasm of 
the laryngeal muscles excited by the ether. By giving more 
air with the ether we can correct this trouble. 

Embarrassed respiration may be due to the accumulation 
of mucus in the upper air passages. In this condition we sim- 
ply turn the head to one side. 

Respiratory failure may be caused by the action of the 
ether on the respiratory centre. In this case we withdraw 
the ether; push the jaw forward by pressing on its angles, 
draw the tongue forward by means of a tenaculum or for- 
ceps and make rhythmic traction of the tongue.' Pour ether 
on the abdomen or chest in order to stimulate inspiration by 
reflex action, give strychnine and atropine hypodermically. 
Practice artificial respiration. 

Name the most common after-effects of the administra= 
tion of ether. 

Nausea and vomiting. 

Under what conditions is ether contra=indicated as an 
anesthetic? 

In acute inflammatory infections of the respiratory tract, 
advanced arteriosclerosis, severe nephritis, especially when 
associated with cardiovascular lesions and anemia when the 
hemoglobin is less than 30%. Diabetes mellitus, especially 
when well established and associated with acetonuria 
(Stevens). 



PRACTICE OF MEDICINE. 



Give the prophylactic treatment of gout. 

As nearly as possible a vegetable diet should be adhered to, 
as animal food gives rise to uric acid. Water should be par- 
taken of plentifully. Alcoholic and malt liquors, especially 
the rich, sweet wines, such as port, sherry, champagne, should 
be particularly prohibited. Systematic bathing, regular ex- 
ercise in the open air, avoidance of exposure to cold and damp- 
ness are important. 

At what age is spasmodic croup most common? Give 
the symptoms and treatment of spasmodic croup. 

The disease is most common in children before the age of 
puberty. The attack begins suddenly, most often at night. 
The first indication is usually a hoarse metallic cough, fol- 
lowed by dyspnea. In severe cases the dyspnea is so extreme 
that cyanosis of the face and extremities occurs. There is 
some elevation of temperature. The cough is unproductive 
at first, but at the close of the attack free expectoration may 
occur. The child should at once be immersed in a warm bath, 
and an emetic promptly given. Inhalations of steam are also 
useful. Between the attacks the child should have tonic 
treatment. 

Give the etiology, duration and prognosis of pertussis. 

It is an infectious disease of early childhood, and common 
between the second and seventh year. The disease usually 
lasts from four to six weeks. The prognosis, as a rule, is 
favorable, the danger being due to complications. 

(613) 



614 PRACTICE OF MEDICINE. 

Describe the treatment of biliary lithiasis. 

The prophylaxis consists in appropriate diet, exercise and 
general favorable hygiene. In women tight lacing should be 
avoided. Warm baths, regular exercise in the fresh air, etc., 
should be recommended. The patient should avoid indul- 
gence in sweet and starchy foods. Constipation should be 
corrected. Massage has been strongly advised. For the 
treatment of the attack hot fomentations should be applied 
over the liver. For the pain hypodermic injections of mor- 
phine give relief. If the condition is not relieved by medical 
means, if the jaundice persist, and especially if symptoms of" 
Charcot's fever appear, surgical interference should be re- 
sorted to. 

Give the etiology and treatment of St. Vitus' dance. 

Chorea is a disease of childhood, although it may occur at 
any age. Females are most often attacked, and the disease is 
more common in the temperate climate. It is most prevalent 
in the spring months. Acute rheumatic fever has been noted 
as an exciting cause in a large number of cases. Fright, 
shock and worry are predisposing causes. It may be due to 
reflex causes, such as intestinal worms, eye-strain, nasal dis- 
ease and sexual disorders. The treatment consists in long 
hours of rest, especially in bed. If the child be attending 
school it had better discontinue and remain at home. The 
diet should be simple, meats and highly-seasoned foods should 
be excluded. Arsenic, antipyrine, bromide of zinc and qui- 
nine are the most useful drugs. 

Give the etiology, symptoms and treatment of cirrhosis 
of the liver. 

The disease occurs most often in the male sex, and is very 
frequently due to alcohol. In the newborn the affection is 
due to hereditary syphilis. The next most important causes 
are acquired syphilis, malaria and other infectious diseases, 
such as cholera, enteric fever and scarlet fever. Gout and 
rickets also give rise to it. The disease may begin without 



PRACTICE OF MEDICINE. 615 

prodromes, except in the case of topers who present a long 
history of gastro-intestinal catarrh. Early in the course of 
the affection there may be some slight enlargement of the 
liver. In the fully established disease the organ is dimin- 
ished in size. Of decided diagnostic import is an early atro- 
phic change in the right lobe of the liver, which in some cases 
can scarcely be felt in the abdomen. Jaundice is absent as a 
rule. The most characteristic symptoms relate to the disturb- 
ance of the circulation in the portal vein, or to the diminished 
function in the atrophied cells of the liver, or they depend 
upon a combination of these two conditions. One of the most 
prominent signs is ascites. Even before this the effect of 
congestion of the mucous membranes of the stomach and 
bowels may be noted by hematemesis and enterorrhagia, which 
occur in the course of this affection. Hemorrhoids occur. 
The spleen is enlarged. The cutaneous veins of the abdomen 
are often greatly enlarged. The urine is diminished in 
amount and is of low specific gravity, frequently reddish in 
color. The temperature is normal or subnormal. The gen- 
eral nutrition suffers greatly, and the patient loses flesh. The 
treatment consists in abstaining from alcohol. Potassium 
iodide and mercury are of use in the syphilitic form. The 
bowels should be carefully regulated, and when ascites be- 
comes prominent, paracentesis abdominis becomes necessary. 

Give the etiology of tetanus. 

The disease occurs in either sex and at any age. It may 
result from a wound in any part of the body, and sometimes 
without apparent trauma. It occurs most often from wounds 
that are exposed to dirt and filth. The exciting cause is the 
bacillus of tetanus described by Kitasato. 

Give the treatment of sciatica. 

Rest by means of splinting the limb is important. Atten- 
tion must be directed to the cause of the disease. If of rheu- 
matic origin the salicylates are of value. Phenacetine, anti- 
pyrine and other members of the coal-tar group are of value ; 



616 PRACTICE OF MEDICINE. 

in severe cases, however, morphine is necessary. Surgical 
measures should only be resorted to after all forms of medical 
relief have failed. 

State the varieties, causes and prognosis of angina pec= 
toris. 

True angina pectoris and pseudo angina pectoris. Occlu- 
sion of the coronary arteries and sclerosis are important fac- 
tors. The true form occurs after middle life, and in the male 
sex ; the pseudo form occurs most frequently in young women, 
in connection with hysteria and neurasthenia. The prog- 
nosis in the true form is very unfavorable ; in the pseudo form 
it is favorable. 

How should insolation (sunstroke) be treated? 

The treatment of thermic fever consists in the application 
of cold to the surface of the body, preferably in the form of 
an ice bath or ice rubbing. The cold pack is sometimes sub- 
stituted. The bath is commonly continued until the temper- 
ature reaches the normal point. Ice water enemata may also 
be employed. Measures should also be taken to guard the 
heart. For this purpose strychnine, digitalis and alcohol 
are useful. 

Give the treatment and prognosis of erysipelas. 

Cold water should be liberally administered to the patient, 
and cold sponging, especially if the temperature is high, is of 
distinct advantage. Ice cloths are also the best treatment 
for the eruption. They should be frequently renewed. An 
ointment of ichthyol and lanolin is also used for this purpose. 
The administration of tincture of the chloride of iron in full 
doses is the general method of treating erysipelas. When 
the nervous symptoms become prominent, or if in the aged or 
cachectic, bold stimulation is necessary; alcohol is best for 
this purpose. If the pain be severe morphine should be re- 
sorted to. Anti-streptococcic serum may be beneficial, and 
should always be resorted to in malignant cases. 



PRACTICE OF MEDICINE. 617 

In simple, uncomplicated cases occurring in those in pre- 
vious good health the prognosis is favorable. The prognosis 
should be regarded as serious when erysipelas occurs as a 
complication of any other malady, or when it results from 
surgical accidents or occurs in the puerperal state. It is 
always serious in alcoholics and cachectics. 

State the etiology and prophylaxis of biliary calculi. 

In a majority of cases they are found in persons of thirty 
and over, and they occur more frequently in the female than 
in the male sex. Catarrh of the bile-ducts and gall-bladder 
may lead to stagnation of bile and to an increase in the amount 
of cholesterin. Farinaceous foods may give rise to the for- 
mation of gall-stones; in diseases in which nitrogenous food 
is largely partaken of, as in diabetes, gall-stones are rarely 
found. They are formed most frequently in the gall-bladder. 
They may occur in the larger gall-ducts, and, rarely, even in 
the smaller biliary passages of the liver. The prophylaxis 
consists in appropriate diet, exercise and general favorable 
hygiene. In women tight lacing should be avoided. Warm 
baths, regular exercise in the fresh air, etc., should be recom- 
mended. The patient should avoid indulgence in sweets and 
starchy foods. Constipation should be corrected. This may 
best be done by the use of waters, such as Carlsbad. Massage 
has been strongly advised. 

What is chronic hydrocephalus? 

As a rule the child's head begins to increase in size soon 
after birth, or it may even be greatly enlarged at birth. There 
is irritability and restlessness, and much impairment of the 
general nutrition ; the child does not grow as is usual with 
normal children, even though the appetite be good. Mental 
development is tardy, and as a rule the child does not learn 
to walk. Ocular phenomena are present, such as strabismus, 
and occasionally optic atrophy. Within a few years vomiting, 
coma and convulsions appear. Death usually takes place 
from exhaustion. 



618 PRACTICE OF MEDICINE. 

Give the etiology and treatment of anthrax. 

This is a widespread disease in animals, occurring all over 
the world. The affection is conveyed to man as the result of 
the handling of wool or hides, rarely by direct inoculation 
from the bites of insects that have fed on animals that have 
died of the disease. It is a very rare affection in man. Cer- 
tain occupations predispose to it, such as those of stablemen, 
tanners, butchers, shepherds and wool-sorters. The exciting 
cause is the bacillus of anthrax. It is important that the 
pustules should be treated surgically, the site of inoculation 
being destroyed by bichloride of mercury, carbolic acid or the 
actual cautery. Constitutional treatment 'Consists in the use 
of quinine, iron, strychnine and alcohol. 

Give the treatment of catarrhal pneumonitis. 

When the temperature becomes high, cyanosis shows itself 
and somnolence is threatened, and a warm bath with cold effu- 
sion to the head is useful. Alcohol is valuable as a circulatory 
stimulant. Inhalations of steam are of value. In strong 
children in whom there is great secretion in the bronchial 
tubes which is brought up with difficulty, emetics may be used 
from time to time, but these should not be continued through- 
out the course of the disease. It is dangerous to administer 
narcotics to young children. Stimulating expectorants, such 
as the salts of ammonia, are often useful. Minute doses of 
strychnine and inhalations of oxygen are of benefit. A mild 
purge at the onset frequently gives great relief. The diet 
should be a light and nutritious one. 

What is the prognosis as to the cure of epilepsy? Give 
the treatment of epilepsy. 

True epilepsy is an incurable affection. Much may be done 
to diminish the number and severity of the attacks, but a true 
cure is rarely met with. In the treatment it is important to- 
relieve the cause if possible. It is best to endeavor to treat 
the epileptic in a colony, in which he may have an out-door 
occupation. The bowels should be regulated, the diet should 



PRACTICE OF MEDICINE. 619 

consist of meat sparingly, fruit, cereals and vegetables. The 
best results have been obtained from the use of the bromides. 

What cutaneous diseases may occur as complications of 
saccharine diabetes? 

Boils, carbuncles, erythema, eczema, especially of the geni- 
tals, purpura, cellulitis and gangrene. 

What is hemophilia? How should it be treated? 

This is a disease characterized by a tendency to hemorrhage, 
which is often uncontrollable, and it is due to a deficiency in 
the coagulability of the blood. The coagulation is retarded, 
and frequently in this condition the blood does not coagulate 
in less than from thirty to fifty minutes. The prophylaxis is 
important ; wounds and operations should be avoided in a per- 
son suspected to be a bleeder. When the bleeding is from a 
free surface and easy of access, compression and rest should 
be tried. Ice, locally, is of value. Calcium chloride and per- 
chloride of iron are recommended by many. Gelatine, collo- 
dion and extract of the suprarenal capsule may be found 
useful when applied to the bleeding surface. Freshly drawn 
blood from a healthy person may be employed as an appli- 
cation. 

Describe the treatment of purulent pleurisy. 

The aspirator should be used, and drainage should be as 
free as possible. If the pus does not flow through the needle 
a surgical operation is necessary. 

Describe the treatment and prophylaxis of nephroliths 
iasis. 

The treatment consists in relieving the pain during an 
attack of renal colic, which is best accomplished by a hypo- 
dermic of morphine or by the inhalation of chloroform. Hot 
baths and hot fomentations to the loins are useful. Fluids 
should be freely partaken of. For uric acid calculi, piper- 
azin, urotropin, and the salts of lithia are of value. The 
waters of various mineral springs are valuable, such as Carls- 



620 PRACTICE OF MEDICINE. 

bad, Ems, Kissingen. Surgical interference is sometimes 
necessary. 

How should cholera morbus be treated? 

Absolute rest in bed is necessary. Food should be given 
sparingly, and it had better be withheld for some time if 
vomiting be frequent. Sterilized milk and animal broths may 
be administered sparingly. Local sinapisms and hot turpen- 
tine stupes are of benefit to allay vomiting. At the onset of 
the disease it is good practice to give a purge. The remedy 
for the condition is opium in some form. Later in the course 
of the affection bismuth and antiseptics which act on the 
intestinal tract are of value. 

What is the treatment of spasmodic stricture of the 
esophagus? 

Dilatation with the esophageal bougie is of value. Remedies 
to act upon the nervous system and tonics are of use. The 
general hygiene of the patient should be carefully looked 
after. 

Give the treatment of hematemesis. 

Absolute rest in bed. Food and drink should be stopped. 
For the thirst small pellets of ice may be taken in the mouth. 
Opium and ergot hypodermically are the best remedies. 

Describe the treatment of rachitis. 

The child should have the best of food, and if the mother 
cannot nurse it a wet-nurse should be procured. Abundance 
of fresh air and sunshine are essential. Daily warm bathing 
is necessary. The child should not be encouraged to walk. 
The remedies that have proven most effective are phosphorus, 
cod-liver oil and the syrup of the iodide of iron. 

Give the treatment of ulcer of the stomach. 

Rest in bed is most important, even in the mildest cases. 
Food should be withheld from the stomach for some time, rec- 
tal alimentation being resorted to. Milk is the best food, and 



PRACTICE OF MEDICINE. 621 

may be given either hot or cold. External applications over 
the stomach, such as hot poultices frequently renewed, are of 
value. Among the most useful of the many drugs that have 
been recommended is bismuth; this remedy should be em- 
ployed in large doses. Salol, oxide of silver, carbonate of 
soda, carbolic acid and cocaine are also highly recommended. 
If there be great pain opium, and sometimes cannabis indica 
are useful. 

Give the symptoms of (a) acute lead poisoning, (b) 
chronic lead poisoning. 

In acute lead poisoning the symptoms may come on in a few 
weeks. Rapid and marked anemia is usually the earliest 
symptom. Constipation, which is followed by excessive diar- 
rhea, vomiting, abdominal tenderness and distension are pres- 
ent. The abdomen, as a rule, is hard and distended. There 
is colic of the severest type over the entire abdomen. The 
paroxysms are of gradual onset and increase in severity. The 
pain is relieved by deep pressure. The temperature, as a rule, 
is subnormal. The symptoms of chronic lead poisoning are 
due to the prolonged absorption of lead in small quantities. 
The anemia may be profound, showing a marked decrease in 
the red blood-cells, with a corresponding decrease in the hem- 
oglobin. There is wasting of the muscles and a peculiar yel- 
low complexion, which, however, is not due to the deposit of 
bile pigment. Along the border of the gums, usually most 
marked under the incisor teeth, is a bluish-black line. Tre- 
mors occur from time to time. There is a metallic taste in the 
mouth, coated tongue, fetid breath, marked dyspepsia and 
obstinate constipation. Lead colic is particularly marked. 
The pain, as a rule, is more severe in the afternoon and at 
night. Occasionally paroxysmal pains occur in the joints 
without swelling, redness or fever. An important symptom 
is lead paralysis. This most frequently occurs as wrist-drop, 
the extensors being particularly affected. Occasionally cere- 
bral symptoms develop, this condition being known as lead 
encephalopathy. 



622 PRACTICE OF MEDICINE. 

Give the treatment of suppurative hepatitis. 

The treatment consists in the early evacuation of the ab- 
scess in suitable cases. Purging with calomel or salts is 
recommended. Opium is best to relieve pain. When the 
septic phenomena are marked, free stimulation should be re- 
sorted to, whiskey and strychnine giving good results. Qui- 
nine is often of use. For the anemia, iron and arsenic should 
be administered. The diet should be light and nutritious. 

What is uremia and how should it be treated? 

Uremia is a clinical condition due to acute or chronic dis- 
ease of the kidney or of its conducting apparatus. Depend- 
ing upon whether the symptoms arise rapidly or suddenly or 
whether they are more insidious, the condition is known as 
acute or chronic uremia. In young subjects with slow pulse 
and high arterial tension bleeding is indicated, and should be 
followed by hypodermoclysis of a normal salt solution. In- 
travenous injections of a normal salt solution are often indi- 
cated. Purging by croton oil and broken doses of calomel 
is useful. For the convulsions, chloral and morphine hypo- 
dermically are the most reliable agents. Sweating should be 
induced by a hot pack or by some similar method. The ad- 
ministration of pilocarpine is accompanied with danger on 
account of its depressing effect upon the heart. 

How should acute nephritis accompanying or following 
scarlet fever be treated? 

Absolute rest in bed is important. It is well to put the 
patient on an absolute milk diet. Some of the alkaline min- 
eral waters, such as Seltzer and Vichy, may be mixed with 
the milk. Daily sponging with warm water and gentle fric- 
tion of the skin are of use. Calomel in fractional doses is 
useful, which may be followed by a saline, even if there be no 
tendency to constipation. Some of the diuretics may be used, 
such as citrate of potash or benzoate of soda. Iron in some 
form is useful, and Basham's mixture is often administered. 



PRACTICE OF MEDICINE. 623 

How should edema of the glottis be treated? 

The treatment is that of dropsy occurring in other parts of 
the body. Surgical treatment, such as scarification, intuba- 
tion, tracheotomy, etc., is often necessary. 

Name one important complication and one important 
sequel of typhoid fever. 

An important complication of typhoid fever is hemorrhage 
from the bowels. An important sequel is phlebitis, which 
most frequently occurs in the left leg. 

What is dysphagia, and with what pathological condi= 
tion is it associated? 

Dysphagia is difficulty or pain in swallowing. It may be 
due to causes in the mouth and fauces, such as glossitis, cancer 
of the tongue, to various forms of stomatitis, tonsillitis and 
pharyngitis. Some of the exanthemata, such as scarlet fever 
and variola, give rise to lesions of the throat, diphtheria, 
spasm or paralysis of the pharynx, disease of the larynx, dis- 
ease of the esophagus, such as stricture, cancer, etc. Finally, 
from pressure from the outside, such as from an enlarged 
thyroid gland, thoracic aneurysm, mediastinal tumor, etc., 
and from pleural and pericardial effusion. 

How would aneurysm of the abdominal aorta affect the 
dorsalis pedis artery pulse as compared with the radial 
pulse? 

The pulse of the dorsalis pedis artery compared with the 
i adial pulse would be small and delayed. 

What conditions predispose to cerebral hemorrhage? 

Heredity is important; many individuals inherit the apo- 
plectic constitution. It is a disease of middle life, and more 
common in the male sex. Diseases of the blood vessels are 
important factors. It may follow the infectious fevers and 
diseases producing disturbances of the blood. Embolism is 
an important factor. Hypertrophy of the heart, exertion or 
excitement frequently cause rupture of the diseased blood 
vessels. 



624 PRACTICE OF MEDICINE. 

What are the causes of endocarditis? 

The greatest number of cases are the result of rheumatic 
fever. Chorea is also a cause. The acute exanthemata also 
give rise to it, also pneumonia, erysipelas, sepsis, puer- 
peral diseases, and sometimes gonorrhea. Tuberculosis, gout, 
renal disease and diabetes are etiological factors. Trauma 
has also been given as a cause. It occurs in fetal life. It 
may sometimes be secondary, from extension of the disease 
from the myocardium or aorta. 

Differentiate between cerebral vomiting and gastric 
vomiting. 

Cerebral vomiting occurs without nausea, often with a clean 
tongue, and is not related to the taking of food. In gastric 
vomiting there is the history of some gastro-intestinal affec- 
tion. The tongue is coated, and there is always considerable 
nausea and much retching. 

Give the characteristic differences between diabetes 
insipidus and diabetes mellitus. 

In diabetes insipidus the urine is of low specific gravity, 
never over 1010 ; there is no sugar present, no itching of the 
skin and genitalia, no hunger, no tendency to the formation 
of carbuncles or boils. In diabetes mellitus the urine is of 
high specific gravity, 1030 and over, sugar is present in the 
urine, there is itching of the skin, great hunger, tendency to 
formation of boils, loss of weight, and frequently an etherial 
odor of the breath. 

Give the cause of vertigo. 

Vertigo occurs in the course of neurasthenia and lithemia, 
from gastric disorders, from arteriosclerosis, valvular disease 
of the heart and aneurysm, from Meniere's disease, from 
reflex causes, such as disease of the eye, nose and larynx. It 
also occurs in many nervous diseases, such as epilepsy, etc. 

Describe pyuria and state its import. 

Pyuria is pus in the urine, and is an important symptom 



PRACTICE OF MEDICINE. 625 

in many diseases of the urinary tract, from the kidney to the 
end of the urethra. It is present in urethritis, cystitis, ure- 
teritis, pyelitis and pyelonephritis. Pus may be caused by 
rupture of an abscess in the urinary tract (especially the 
bladder) ; this may occur in salpingitis, abscess of the ovary, 
extra-uterine pregnancy, cysts of various kinds, psoas and 
other forms of abscess, etc. 

Describe leukemia and mention the pathological changes 
occuring in this disease. 

Leukemia is a disease in which the white blood corpuscles 
are greatly increased in number ; the percentage of the various 
forms also differ greatly from the normal. It is character- 
ized anatomically by changes in the spleen, lymphatic glands 
or bone marrow, singly or combined. In the splenomedullary 
form the spleen is greatly enlarged, and it may weigh ten 
pounds or more. The capsule is thickened, and the surface 
of the organ somewhat irregular. On section it is quite firm. 
The color of the pulp is reddish-brown. Infarcts are common. 
The gross appearance of the blood is altered, occasionally 
being milky in character, the specific gravity is decreased, the 
alkalinity is somewhat diminished, and coagulation is slightly 
retarded. The leukocytes show a great increase in number, 
from 250,000-500,000 or more per cmm. In the lymphatic 
variety groups of lymph glands are enlarged, owing to hyper- 
plasia of the lymphoid cells, and the spleen is slightly increased 
in size. The gross appearance of the blood may show very 
slight change or resemble the variety just described. The leu- 
kocytes are also greatly increased in number, but not to the 
extent that they are in the splenomedullary form. Exami- 
nation of the stained films shows an enormous increase in the 
lymphocytes. 

Give the symptoms indicative of impacted gallstone. 

When the gallstone has become impacted there is an -arrest 
of the pain. Jaundice is marked, the urine shows bile pig- 
ments, and the stools are clay-colored. There is hepatic inter- 
40 



626 PRACTICE OF MEDICINE. 

mittent fever, sometimes called Charcot's fever. This con- 
sists of high temperature, chills and sweating. While this 
fever is paroxysmal, it does not show the regularity of a 
malarial attack. 

Give the treatment of yellow fever. 

Disinfection of the person and all effects. Strict quaran- 
tine. A mild cathartic may be given at the onset with advan- 
tage. Vomiting and gastric irritability may be treated by 
the administration of carbolic acid, cocaine or broken doses 
of calomel. The fever should be treated by cold applications 
to the head and cold sponging. For the pain opium in some 
form is useful. Strychnine is valuable as a cardiac tonic. 
For the hemorrhage, opium, ergot and suprarenal extract 
may be administered. 

Outline appropriate treatment for Asiatic cholera. 

Complete isolation of the sick and thorough disinfection of 
all discharges and all articles of clothing are absolutely 
necessary. Efficient quarantine must be established. All 
milk and water should be boiled, and no raw fruit or vege- 
table should be eaten. In the stage of premonitory diarrhea 
it is considered good practice to administer a prompt laxative. 
If there be great pain opium may be given hypodermically. 
Salol and guaiacol carbonate may be given from time to time 
as intestinal antiseptics. In the stage of serous diarrhea the 
patient should be wrapped in flannels and external heat ap- 
plied to the body. If there be cramp, friction of the muscles 
is useful. Fluids should only be allowed in very small quan- 
tities. Enteroclysis should be used in this stage. When col- 
lapse sets in, hypodermoclysis of a normal salt solution should 
be given. Strychnine may be given by the skin, but it must 
be remembered that as absorption is slow, accumulation may 
occur. 

What are the causes and treatment of palpitation of the 
heart? 

This may be due to reflex causes, such as disease of the 



PRACTICE OF MEDICINE. 627 

stomach, disease of the genito-urinary apparatus, and sexual 
excesses. Toxic causes may give rise to it, such as the abuse 
of alcohol, tobacco, tea and coffee. G-out and anemia are 
productive features, and the condition occurs in inanition and 
marasmus. Finally, it is due to disease of the heart itself, 
such as organic disease, and it is an important symptom of 
exophthalmic goitre. The treatment consists in removing the 
cause, if possible, and is then symptomatic. Rest in the re- 
cumbent posture and an icebag over the heart are useful. 

What are the causes and symptoms of dilatation of the 
stomach? 

The dilatation may be acute or chronic. It may be due to 
obstruction of the pyloric end of the stomach, such as con- 
genital stenosis, the cicatrices resulting from gastric • ulcer, 
and from tumors, the most common being malignant, Motor 
insufficiency of the stomach may give rise to dilatation; this 
may result from overeating or drinking, and frequently occurs 
in beer drinkers. The symptoms are general feebleness, ane- 
mia, emaciation, thirst, scanty urine, sallow and hollowed face, 
flabby coated tongue, pyrosis, chilliness, cyanosis, subnormal 
temperature and nervous symptoms. Pain and vomiting are 
always present. The outline of the stomach may be demon- 
strated by means of the X-ray. 

What is scurvy, how should it be prevented and treated? 

Scurvy is an affection characterized by anemia, by swollen, 
tender and bleeding gums, by manifestations of purpura and 
by great prostration due to improper food. The prevention 
of the condition is accomplished by the use of anti-scorbutic 
food. In the treatment, antiseptic mouth washes are of use. 
Fresh vegetables should be administered. Lemon-juice is very 
valuable, as are also bitter tonics. 

Give in detail the treatment of diphtheria. 

The prophylaxis is highly important, the disease being very 
contagious and easily transmitted. The patient should be 
strictly isolated. Efficient disinfection is also necessary. 



628 PRACTICE OF MEDICINE. 

The food must ! be nutritious and easily digested. If the 
patient cannot swallow, rectal alimentation must be resorted 
to. Alcohol is necessary, and must be given freely, even in 
mild cases. The membrane must not be removed. Antiseptic 
and soothing applications are employed ; inhalations of quick- 
lime and steam in all cases in which there is danger of invasion 
of the larynx are useful. Hydrogen dioxide in solution is 
serviceable as a mouth wash. Internally, the tincture of 
chloride of iron may be given in medium doses. Calomel or 
corrosive sublimate in appropriate doses are useful. The 
antitoxin treatment, however, is the most important. The 
dose in individual cases varies; 3,000 antitoxin units may 
be given at ■ a dose, but this may be increased in severe 
eases and repeated. In laryngeal cases intubation and tra- 
cheotomy may have to be resorted to. 

What is the prognosis of suppurative nephritis secondary 
to cystitis? Outline the treatment of the condition. 

The prognosis is unfavorable, and the treatment is surgical. 
Give the etiology of tubercular peritonitis and the treat= 
ment. 

The disease appears at all ages, but it is most common in 
childhood. Males are more frequently attacked than females, 
and it is more often met with in the negro than in the white 
race. It is also found associated with intestinal or mesenteric 
tuberculosis. The condition may be primary in the perito- 
neum, and may be confined solely to this membrane. A com- 
mon mode of infection is through the intestines ; this may also 
occur through the lymphatics or by extension from the pleura 
or the pericardium. It is often of the miliary variety, but 
also of the chronic ulcerative and chronic fibroid forms. The 
modern treatment of this condition is surgical, the best results 
having been obtained by opening the abdomen and producing 
adhesions. 

Outline a plan of treatment of typhus fever. 

The prophylaxis is of the greatest importance. An abund- 



PRACTICE OF MEDICINE. 629 

ant supply of good food, fresh air and free ventilation are 
important. Stimulation is necessary on account of the severe 
prostration. If hyperpyrexia occur the cold bath should be 
resorted to. Strychnine may be necessary as a respiratory 
and cardiac stimulant. Complications are treated as they 
arise. The constipation must be relieved by enemata, and in 
convalescence tonics should be administered. 

Give the treatment of pyelitis. 

The patient must be kept in bed and protected against cold. 
A bland diet should be given and the alkaline mineral waters 
freely used. Application of heat to the renal region should 
be resorted to. Warm baths are grateful to the patient. 
Opium in some form to relieve the pain is necessary. In 
chronic pyelitis astringents are indicated, such as acetate of 
lead. Salol and methylene blue are sometimes found of ben- 
efit. Surgical interference is necessary if hydronephrosis or 
pyelonephrosis is present. 

Mention the most reliable remedy for pulmonary hem= 
orrhage. 

Rest in bed, abstaining from food and drink, an ice-bag 
applied to the chest, and opium and ergot. 

What remedies should be used in hemorrhage from 
mucous surfaces? 

Opium, ergot and suprarenal capsule. 

What are the complications and sequelae of whooping 
cough? 

Hemorrhages occur, such as petechia?, about the face and 
neck ; epistaxis and hemoptysis may occur ; broncho-pneumonia 
is a complication which adds greatly to the gravity of the 
case. Pulmonary tuberculosis is comparatively frequent in 
a considerable proportion of the cases, especially in adoles- 
cents. 

Describe the treatment of paralysis agitans. 

The treatment is purely symptomatic. Occasionally hyos- 



630 PRACTICE OF MEDICINE. 

cyamine or hyoscine control the tremor. The general hygiene 
of the patient is to be looked after; tonics, such as arsenic and 
strychnia, are of use. 

What are the causes of peritonitis? 

The most frequent mode of infection is through the intes- 
tines and from the female generative organs. Various forms 
of ulcer may produce peritonitis, such as the typhoid or tuber- 
cular ulcer. Malignant disease of the intestine may give rise 
to it. It also arises from forms of intestinal obstruction, such 
as volvulus and stricture. The gall-bladder and liver may 
be the sources of infection, and particularly abscesses, and 
syphilitic disease may give rise to it. Obstruction of the 
biliary passages by gall-stones may produce it. The affection 
may arise from the spleen, through an infected embolus. _ It 
may occur from infective disease of the kidney, from disease 
of the bladder wall, from the prostate and from the urethra. 
Peritonitis occasionally occurs in the course of some of the 
acute infectious diseases, such as erysipelas, acute rheumatic 
fever and septicemia. 

Name the places where yellow fever is endemic. 

The disease is endemic in the West Indies, parts of the 
Mediterranean coast, South America and Africa. 

What treatment would you recommend for diphtheritic 
paralysis? What is the prognosis? 

Rest, tonics, strychnia, and, later, electricity are useful. 
The prognosis in all forms of diphtheritic paralysis is favor- 
able as a rule, except in paralysis of the heart. 

What are the causes and treatment of acute myelitis? 

Exposure to variations of temperature, especially to cold, is 
important. Thus certain occupations predispose, such as engi- 
neers, cabmen, drivers, etc. Gout, rheumatism and certain 
metallic poisons, such as lead, mercury and arsenic, have been 
recognized as etiologic factors. Alcohol may also be a cause. 
Syphilis usually gives rise to the chronic form. Occasionally 



PRACTICE OF MEDICINE. 631 

acute myelitis may be secondary, resulting from extension, as 
in abscess, caries or cancer of the spine. Traumatism is p< 
haps the most common cause. The puerperal period and the 
existence of septic conditions have also been noted as causes of 
the disease. In the treatment, counter-irritation by blisters or 
the application of cold are of use in the acute stage, but they 
are contra-indicated after this stage. Precaution should be 
taken not to interfere with the nutrition of the skin on account 
of the great liability to trophic changes. Absolute rest is 
important. Great care must be taken of the bladder. The 
catheter should be carefully sterilized. Electricity is benefi- 
cial late in the course of the disease, and at this time massage 
is also valuable. A warm climate favors improvement, Hy- 
drotherapy has been highly recommended. General tonics 
are of use; the bowels may be moved by enemata. In syphi- 
litic <?ases anti-syphilitic treatment is indicated. 

What are the complications and sequelae of scarlet 
fever? ' 

■Oiphthrri'n fte^r-nephritis -aw the most important complica- 

Ar 

tions, and occur^in nearly all severe cases. Endocarditis 
occurs; less commonly pericarditis. Meningitis, peritonitis, 
pleurisy, with and without effusion, also occur. Among the 
most common sequels are enlarged lymphatic glands, chronic 
joint affection, the hemorrhagic diathesis, monoplegia, hemi- 
plegia, peripheral neuritis, hysteria and anemia. 

On what symptoms would you base a diagnosis of ty= 
phoid fever? 

Upon the slow onset, with a gradual rise in temperature, 
nose-bleed, headache, diarrhea, the occurrence on or about the 
seventh day of the typical eruption, enlargement of the spleen, 
dilated pupils, the "Widal reaction, and the dicrotic pulse. 

How should scarlatina be treated? 

Strict isolation is important. The scales during the period 
of desquamation should be carefully collected and burned. 
The diet should be nutritious and easily assimilated. Pure 



632 PRACTICE OF MEDICINE. 

drinking water or the alkaline mineral waters may be freely 
administered. Milk is a necessary article of diet. There is 
no specific treatment. A mild laxative should be given at the 
onset. Tepid sponging, at least twice daily, is necessary in 
severe cases. Warm bathing is usually very grateful to the 
patient. During the period of eruption an animal fat, used 
as an inunction to the skin, prevents itching and hastens des- 
quamation. A mild diuretic may be used, and it is important 
to keep the kidneys active. Complications must be treated 
upon general principles. 

What should be done for a patient during the passage of 
a biliary calculus? 

Hot fomentations should be applied over the lower part of 
the liver. If the pain is severe, whiffs of chloroform may be 
inhaled. However, in the majority of the cases relief of the 
pain only follows the hypodermic use of morphine. If the 
condition is not relieved by medical means surgical interfer- 
ence must be resorted to. 

How should srnall=pox be treated? 

Vaccination should be practiced as a prophylaxis. Com- 
plete isolation and disinfection are absolutely necessary. 
There is no specific treatment. Food is not well borne at first, 
and there may be much vomiting and diarrhea. Usually acid 
drinks or small particles of ice are grateful to the patient. 
From the onset of the disease detergent washes containing 
antiseptic solutions should be used for the mouth. The room 
should be darkened; the solar light being rigidly excluded. 
This prevents pitting. Warm baths two or three times 
daily are of decided benefit to the patient. During the 
time of secondary fever bold stimulation is necessary. At 
the onset a laxative is useful. Pain should be overcome by 
small doses of opium, but great care must be exercised with 
this drug, as it tends to lock up the secretions. Restlessness 
and insomnia should be treated by trional and sulphonal. In 
convalescence tonics are useful. 



PRACTICE OF MEDICINE. 633 

What is the treatment for angina pectoris? 

For the attack, hypodermics of morphia are necessary. In- 
halations of amyl nitrite'of nitroglycerin in full doses may 
prove beneficial. In the interval between the attacks the 
patient must lead a quiet life. The functions of the body 
should be veil looked after, and the administration of the 
nitrite of sodium with strychnine is of use. 

What should be done to give relief in intestinal obstruc= 
tion? 

The treatment is largely surgical. Opium should be given 
to relieve the pain. If vomiting be persistent the stomach 
tube may be used. Purgatives should be avoided. Hot tur- 
pentine stupes may be applied to the abdomen. Rectal feed- 
ing may be resorted to, but surgical interference sooner or 
later becomes imperative. Atropine in large doses hypoder- 
mically has been advised. 

What causes cerebro=spinaI meningitis, and how should 
it be treated? 

The exciting cause is the diplococcus intracellularis menin- 
gitidis, described by Weichselbaum in 1887. The treatment 
is purely symptomatic. Cold applications to the head and to 
the spinal cord are useful. On the other hand, heat to the 
head and spine may be preferred by some patients. A laxa- 
tive dose of calomel early in the course of the disease and 
mercury throughout the entire affection has many advocates. 
Opium perhaps offers the best mode of treatment, and there 
is a remarkable tolerance for this drug even in the very 
young. If vomiting be a prominent symptom morphine 
should be given hypodermically. Chloral, the bromides and 
cannabis indica have been used, but in effect cannot be com- 
pared with the systematic use of opium. Alcohol is necessary 
when depression shows itself and asthenia is marked. 

Describe the treatment of pericarditis. 

In the first stage ice-bags applied over the precordium are 



634 PRACTICE OF MEDICINE. 

of use in relieving pain and quieting the cardiac action. 
Small blisters at some distance from the precordium are of 
benefit, especially when there is an effusion. If pain be 
severe opium in some form is necessary. In very large effu- 
sion paracentesis is necessary, especially so if the effusion be 
purulent, in which condition surgical interference is impera- 
tive. Gentle purges from time to time are useful. A mild, 
non-stimulating diet is indicated. 

How should apoplexy due to cerebral hemorrhage be 
treated? 

The patient must be placed in bed with the head elevated. 
If arterial tension be high venesection should be performed 
immediately. Ice-bags are applied to the head. Croton oil 
or calomel is of great value in inducing free purgation. If 
the patient be unconscious for a considerable length of time 
the bladder must be evacuated with a catheter. 

What is the treatment of diarrhea occurring in typhoid 
fever? 

Large doses of bismuth, salol and some of the intestinal 
antiseptics are of value in this condition. Opium must be 
administered with great caution. 

Give the treatment of whooping=cough. 

Food should be abundant and nutritious, and if the child 
vomits during a paroxysm nourishment should be immediately 
readministered. Antipyrine in doses proportionate to the 
age of the patient has some influence on the paroxysms. 
Bromoform is of use, but is very likely to give rise to nausea. 
Good hygiene is essential in the treatment of the case. 

What measures should be adopted in the treatment of 
pulmonary edema? 

The treatment is largely that of the primary disease which 
causes the edema. There should be active purging, especially 
if cyanosis be absent. Hypodermics of atropia in large doses 
frequently repeated have been found of use in some cases. 



PRACTICE OF MEDICINE. 635 

s- How should endocarditis be treated? 

The treatment consists in absolute rest in the recumbent 
posture. Digitalis should only be given for definite and fixed 
indications, and is not required unless the pulse becomes quick 
and small or irregular, or the signs of failing compensation 
occur. Strychnia is of benefit in this condition. If anemia 
persists, iron with quinine and arsenic will be found valuable. 

What measures should be employed to rid the system of 
tape=worm. 

The most reliable anthelmintics are the male fern, the pome- 
granate root, bark and its alkaloid pelletierin, kousso, pump- 
kin seed, turpentine and chloroform. Thymol is also highly 
recommended by some authorities. Before the administration 
of any of these drugs the patient should be put upon a milk 
diet for at least twenty-four hours. It is then desirable the 
night before the vermifuge is administered to give a brisk 
cathartic, preferably calomel. Early the following morning 
the anthelmintic is administered, and a few hours afterward 
another purgative. 

What are the ordinary age limits of typhoid fever, and 
what conditions are essential to its production? 

The age at which enteric fever most frequently occurs is 
from 15 to 30. The predisposing causes are temperate cli- 
mate, autumn months, unfavorable hygienic surroundings, 
such as infected drinking water, food, sewage and poor drain- 
age. The exciting cause is the bacillus of Eberth or the ba- 
cillus typhosus. 

How does the cause of typhoid fever principally gain 
entrance to the human body? Outline the prophylaxis. 

Most frequently through the digestive tract in the form of 
infected drinking water or milk. The prophylaxis consists 
in the absolute destruction of the discharges and disinfection 
of the soiled linen. The drinking water should be boiled, and 
suspected milk should also be boiled. 



636 PRACTICE OF MEDICINE. 

Describe the treatment of cancer of the stomach. 

The most important point in the treatment relates to the 
early diagnosis, with the hope of operative interference. 
Medical methods are only palliative. They consist in allevi- 
ation of the dyspeptic conditions and the pain. To accom- 
plish these ends systematic lavage and the use of opium are 
the most satisfactory agents. Strength may be maintained 
by rectal alimentation. 

Give the period of incubation and the treatment of 
mumps. 

The period of incubation is about two weeks. It may be as 
long as three weeks. In the treatment the patient should be 
isolated, and a mild laxative given at the onset. Rest in bed 
is important. Attention should be given to the alleviation 
of pain. 

Describe herpes zoster and its treatment. 

One or more groups of small vesicles seated upon a plane 
base and attended by neuralgic, burning pain, occurring along 
the course of one or more branches of a nerve, is known as 
herpes zoster. The process is acute and self-limited. Mild 
cases rarely require any constitutional treatment. In the 
more severe cases remedies which in^prate the nervous sys- 
tem are of value. Zinc phosphide / /|eve?y three or four hours 
seems to be of service, and in some cases quinine and strych- 
nine are useful, also arsenic. If the pain be very severe 
opium in some form is useful. Antipyrine, phenacetine and 
salicylate of sodium have been highly recommended. A dust- 
ing powder consisting of oxide of zinc, boric acid and talc 
should be applied over the vesicles. This may be changed 
daily or every few days. 

Give the symptoms and treatment of exophthalmic 
goitre. 

The four cardinal symptoms of exophthalmic goitre are 
enlargement of the thyroid gland, protrusion of the eyeball, 




PRACTICE OF MEDICINE. 637 

tachycardia and tremor. Hydrotherapy is often valuable; 
rest in bed and ice-bags applied to the preeordium give much 
relief to the patient^ Digitalis, aconite, veratrum viride, 
tincture of strophanthus and potassium bromide have been 
employed in this disease. Thyroid extract has also been lately 
recommended. Removal of the thyroid gland has been prac- 
ticed with but little benefit. 

Name five diseases caused by a known germ. 

Tuberculosis, enteric fever, cholera, plague and diphtheria. 

Describe the treatment of neurasthenia. 

The study of the individual case is important. The rest 
cure is applicable in many cases, while in others a change of 
climate is of great benefit. Hydrotherapy, electricity, mas- 
sage and hypnotism have all been of value in the treatment. 
The diet must be easy of digestion. In the cerebral A T ariety 
the bromides are valuable. In the gastric variety arsenic in 
the form of Fowler's solution is of service. Syrup of the 
hypophosphites and valerian, caffeine, hyoscine and phenace- 
tine are of benefit in suitable cases. Opium and other hyp- 
notics must be used with great caution. Iron and cod-liver 
oil are useful. Systematic exercise is of great benefit. 

Give the morbid anatomy and physical signs of acute 
endocarditis. 

The lesions are usually situated in the left side of the heart. 
The endocardium lining the valves is most frequently affected. 
The lesions are small vegetations varying in size from one to 
four millimeters in diameter. Usually micro-organisms are 
associated with simple endocarditis. Microscopically the first 
change noted in the endocardium is the granular degeneration 
of the epithelial cells. In the sub-endothelial tissues blood- 
vessel changes that accompany inflammation are noted. Co- 
agulation necrosis and the proliferation of the fixed cells 
are found. The inflammatory exudate, the sub-endothelial 
tissues and the fibrin upon the free surface cause the bulging 



638 PRACTICE OF MEDICINE. 

or warty excrescences. Upon this projection, fibrin from the 
blood stream is also deposited. Intermingled with the exu- 
date the various micro-organisms may be present. E>arly on 
inspection no change is usually noted, and the important 
physical signs can only be discovered upon auscultation. As 
the mitral valve is most frequently involved, a systolic mur- 
mur, which has its maximum intensity at or near the apex, 
and is transmitted to the left axilla, and often to the angle 
of the scapula, shows that mitral regurgitation has taken 
place. The murmur is at first soft and blowing in character. 
When other valves are implicated murmurs related to them 
occur. 

Mention the causes and symptoms of gastralgia. 

The condition consists in severe boring, rumbling, painful 
contraction in the epigastric region extending from the 
xiphoid cartilage and radiating to the back, accompanied by 
syncope and signs of collapse. The condition may appear 
suddenly without apparent cause, or may be due to slight 
pressure in the epigastrium. It may be accompanied by the 
sensation of the globus hystericus, bulimia, frequent micturi- 
tion and vomiting. It disappears after having lasted a few 
moments. The attacks occur with marked irregularity, occa- 
sionally several taking place in one day, upon alternate days, 
or not recurring for months. It is a neurosis of the stomach. 

Describe the treatment of leukemia. 

Rest in bed is desirable, and a nutritious diet should be 
given. Arsenic should be administered early, and the dose 
increased to the point of tolerance. This drug seems to have 
a marked beneficial effect. Ergot has been recommended; 
bone marrow and iron are also found to be useful, especially 
when arsenic is not well borne. Oxygen inhalations may be 
beneficial. 

Describe the symptoms and treatment of multiple 
sclerosis. 

The first symptoms may appear after some mental or phys- 



PRACTICE OF MEDICINE. 639 

ical strain, the patient behaving as if affected by hysteria. 
There may be temporary aphonia, from which there may be 
speedy recovery, or numbness may occur in some part of the 
body. These symptoms may disappear for a time and re- 
appear with increased severity. Charcot has given the fol- 
lowing description : The patient develops spastic paraplegia 
with exaggerated reflexes, with ankle clonus and limited 
movements. An irregular jerky tension tremor occurs, nys- 
tagmus being a prominent symptom. Diplopia and paralysis 
of the ocular muscles are common. Scanning speech is prom- 
inent. There are parasthesia, tinnitus aurium and vertigo. 
The mental faculties are blunted, and in some few cases apo- 
plectiform and epileptiform convulsions occur. Trophic 
changes arise late in the disease, the sphincters, however, 
remaining normal. The treatment is the same as in other 
forms of sclerosis. The salts of gold, silver and arsenic have 
been recommended. 

Describe the eruptions in the eruptive fevers. State 
where they first appear and the time of their appearance. 

In scarlet fever the eruption occurs at the end of the first 
day or beginning of the second day. It consists of pin-head 
points appearing first upon the neck and chest and spreading 
rapidly all over the body, except certain parts of the face, the 
mouth and chin. These red points, which are close together, 
soon coalesce, giving a diffuse pinkish or reddish appearance 
to the entire skin, which presents a boiled lobster color. Some 
slight edema may also be noted. Throughout the entire erup- 
tion raised papules are found. The eruption lasts about four 
or five days, and disappears by desquamation. 

The eruption in measles occurs upon the fourth day. It 
appears first upon the face and neck, and spreads rapidly 
over the entire body. The eruption consists of rose-red or 
brownish maculo-papular points raised above the skin, with 
intervening healthy skin, often arranged in a crescentic shape, 
especially upon the forehead and wrists. The eruption re- 
mains at its height for about four clavs. 



640 PRACTICE OF MEDICINE. 

The eruption in rubella appears upon the first day, and 
occurs irregularly over the face, neck, chest, body and limbs, 
varying in individual cases and in different epidemics. The 
multiform eruption may resemble erythema, urticaria, and 
in some cases that of true measles or scarlet fever. It may 
be confluent or diffuse, lasting from two to four days. 

The eruption in small-pox occurs upon the third day. The 
temperature falls as the eruption occurs. The eruption may 
be discrete or confluent. At first the rash is about the size 
of a pin-head, and soon becomes hard, feeling like a shot 
under the skin. The macular eruption is rapidly converted 
into a papule of a reddish color. There may be itching and 
burning attending these early eruptive symptoms. In from 
twenty-four to forty-eight hours the rash has invaded the en- 
tire body, the earlier papules soon become vesicular, this 
change taking place about the sixth or seventh day from 
the onset of the attack. In a day or so the fluid becomes 
turbid and purulent, the top being held down (primary um- 
bilication). In from twenty-four to forty-eight hours this 
umbilication has disappeared, the top now being conic in 
shape. About this time an intense red inflammatory areola 
is noticed about the base of the pock, and the eruption is now 
exceedingly painful. On or about the ninth day from the 
beginning of the disease suppuration begins in the pock, last- 
ing about three days, when the apex of the cone drops in, due 
to the absorption of the contents of the pock (secondary um- 
bilication). When absorption has been completed a crust 
forms that may remain for some days, these crusts falling off 
on or about the sixteenth day from the beginning of the dis- 
ease, leaving depressed striated scars. 

The eruption in varicella occurs upon the first day, and 
marks the beginning of the disease. The exanthem shows its- 
self as a small reddish point or papule, which in a very few 
hours becomes a vesicle. It is slightly elevated above the 
skin rather than having the appearance of being under the 
skin; the vesicles are thin and transparent, and from one- 



PRACTICE OF MEDICINE. 641 

eighth, to one-quarter of an inch in diameter. There is usually 
no areola. In the course of a few hours the vesicle becomes 
milky and begins to shrivel, with depression at the top from 
absorption of its contents. This results as a yellowish-brown 
crust that in about ten days from the beginning of the at- 
tack, and even before this, separates, leaving a more or less 
well-defined scar, which in some cases, especially upon the 
face, remains permanently. The pocks may appear upon the 
face, neck, scalp, wrist and some parts of the body. 

Give the symptoms of acute pericarditis. 

It is impossible to diagnosticate a true pericarditis by 
symptoms without a careful physical examination. The dis- 
ease commonly begins with severe pain in the region of the 
precordium. The pulse rate increases, and may be from 90 
to 160 per minute. In some cases it may be normal, or when 
effusion occurs the pulsus paradoxus occurs. Fever of some 
degree is usually present. The most important sign is a fric- 
tion sound, which varies greatly in intensity. It is limited 
to the precordial area, and is heard most frequently at the 
base of the heart. It is increased by pressure with the stetho- 
scope. If an effusion develops the friction sound disappears, 
and returns again as absorption takes place. 

What are the complications and sequelae of cerebro= 
spinal fever? 

The important complications are broncho-pneumonia, bron- 
chitis, croupous pneumonia, endocarditis and pericarditis. 
The sequels are exceedingly common. They consists in affec- 
tions of the special senses. There may be loss of sight, per- 
manent deafness, loss of smell, loss of taste, various forms of 
paralysis and neuralgia. 

Describe the eruption of typhus fever. 

The characteristic eruption of typhus appears upon the 
fifth day of the disease, and in its early stages closely resem- 
bles measles. Macular spots of irregular size and outline, 
41 



642 PRACTICE OF MEDICINE. 

and of a dirty pinkish or reddish color, characterize the ex- 
anthem. It appears first upon the chest and abdomen, and 
extends to the extremities, the face being rarely affected. It 
is particularly copious upon the extremities, where later in 
the disease it becomes darker or petechial. Another erup- 
tion is also characteristic, and consists of marbling or mottling 
of the skin. This rash lasts throughout the disease, and does 
not disappear in death. 

Describe the treatment of measles. 

There is not specific treatment, and in uncomplicated cases 
medicines are unnecessary. A mild laxative at the onset is 
useful. The entire treatment should be directed to the pre- 
vention of complications, especially broncho-pneumonia. When 
complications occur they must be treated upon general prin- 
ciples. 

Give the physical signs of a cavity of the lung in pul= 
monary tuberculosis. 

If the cavity be large and superficially situated there will 
be depression upon inspection. Upon palpation, if the cavity 
be empty, there will be increased vocal fremitus. Upon per- 
cussion, if the cavity is empty, a tympanitic note may be elic- 
ited. If the cavity communicate with the bronchus a cracked- 
pot sound may occur. If the cavity be filled dulness will be 
noted upon percussion. On auscultation, if the cavity be 
empty, increased vocal resonance and cavernous breathing 
will be heard. If fluid be present in the cavity bubbling rales 
are heard. Around the cavity a friction sound is frequently 
noted. 

Give the etiology and treatment of hemothorax. 

Hemothorax may result from traumatism, caused by frac- 
ture of a rib or wounding of a lung. It may also result from 
rupture of an aneurysm, from malignant disease of the lung, 
and in the hemorrhagic diathesis. If the hemothorax be mod- 
erate in size it should not be interfered with, as subsequent 



PRACTICE OF MEDICINE. 643 

absorption and clotting will take place. Rest and the free 
administration of opium are necessary. Avoid stimulation, 
for it will interfere with the formation of a clot. 

Describe the characteristics and significance of the 
several kinds of arterial pulse. 

The normal radial pulse is characterized by regularity, fair 
volume, and, in the healthy adult, is from 70 to 80 per minute 
in the erect posture. The pulse of aortic regurgitation is 
known as the water-hammer or Corrigan pulse. It makes 
itself known by an apparent fulness, which, however; soon 
passes, and it recedes from the finger, hence it is also known 
as the receding pulse. The pulse of mitral stenosis is a small, 
irregular, rapid pulse. The dicrotic pulse conveys to the 
finger a double beat. 

— Diagnosticate diabetes mellitus. 

The diagnosis of diabetes mellitus consists in the continuous 
presence of glucose in the urine. The amount of urine passed 
by the patient may be from 3 to 5 quarts in the 24 hours ; its 
specific gravity is high, 1030 or over. The color is usually 
straw-colored, and the urine is clear. The patient has great 
thirst, large appetite, as a rule loses weight, and an etherial 
odor may often be detected in the breath; there is pruritus, 
especially of the genitals, and boils and carbuncles are apt to 
form. 

Differentiate gastric cancer from gastric ulcer. 

Gastric cancer occurs after the age of 40, most frequently 
in the male sex; gastric ulcer is a disease most frequently 
occurring in young females in whom chlorosis is often present. 
Gastric cancer is characterized by loss of weight, marked 
cachexia, and often by the presence of a tumor in the region 
of the pylorus. There is pain which, as a rule, is dull in char- 
acter and not particularly aggravated by food. Vomiting 
occurs after a longer period, 24 hours or more, of food which 
is but partially digested. The Oppler-Boas bacillus may be 



644 PRACTICE OF MEDICINE. 

present in the vomited material, and there may also be tinges 
of 'blood. In ulcer there is pain and marked tenderness in 
the region of the ensiform cartilage. This pain is greatly 
aggravated by the taking of food ; vomiting occurs soon after 
a meal ; there is frequently hematemesis. In the examination 
of the gastric contents it will be found that in cancer there is 
an absence of free HC1 and the presence of lactic acid, while 
in ulcer there is an excess of free HC1. 

Differentiate scarlatina, measles and roseola. 

In scarlatina the eruption appears late on the first day or 
early on the second day of the disease, while in measles it 
appears on the fourth day, and in roseola the eruption is the 
first symptom of the disease. The onset in scarlet fever is 
abrupt, with a chill or convulsion, high temperature, rapid 
pulse, 140-160 per minute or more, sore throat, etc. In measles 
the onset is characterized by marked catarrhal symptoms, such 
as sneezing, coughing, lachrymation, etc.; the temperature 
moderate, there is slight sore throat and mild gastric dis- 
turbance. 

How would you diagnose pneumonia? 

The direct diagnosis of pneumonia depends upon the sudden 
onset with chill, temperature which, as a rule, is high, severe 
pain in the side, cough, at first with scanty expectoration, later 
the expectoration becoming very tenacious and containing 
blood (rusty sputum), and upon the physical signs. These 
consist of the crepitant rale in the first stage, dulness on per- 
cussion in the second stage with bronchial breathing, and the 
occurrence of the crepitus redux in the third stage. 

Differentiate peritonitis and enteritis. 

In peritonitis there are present marked abdominal pain, 
tenderness on pressure, abdominal distension, after which 
effusion is apt to occur, vomiting, which becomes persistent, 
fever and perhaps the occurrence of collapse ; marked consti- 
pation is an important symptom. In enteritis there is diar- 



PRACTICE OF MEDICINE. 645 

rhea, there is rarely marked distension, no abdominal rigidity ; 
as a rule, there is the history of some dietary error. 

Differentiate organic and functional heart murmur. 

Organic murmurs may be systolic, presystolic or diastolic in 
time. There is evidence of cardiac hypertrophy, dilatation, or 
both. The murmur is conducted in certain definite direc- 
tions (except the presystolic murmur). A thrill is sometimes 
present. A functional murmur is always systolic in time; it 
is heard at the base, particularly at the left base (whereas 
the organic murmur is heard at the punctum maximum), it is 
not transmitted, there is no evidence of hypertrophy or dila- 
tation, and it is present in anemic conditions. 

Describe three pathological pulmonary sounds heard on 
auscultation, and give their significance in diagnosis. 

The friction sound which may be heard in inspiration, expi- 
ration or both, which indicates a fibrinous pleurisy. A crep- 
itant rale, which usually indicates fluid in the vesicular struc- 
ture of the lung. Amphoric breathing, showing a cavity. 

Differentiate aortic stenosis and aortic insufficiency. 

In aortic stenosis the murmur is systolic in time, transmitted 
to the arteries of the neck; a systolic thrill is also often pres- 
ent, there is some evidence of hypertrophy of the left ventri- 
cle, the pulse is full and, as a rule, not rapid. In aortic 
regurgitation the murmur is diastolic in time, heard at the 
left base, conducted down the sternum. The water-hammer 
or Corrigan pulse is present. There is marked evidence of 
hypertrophy of the left ventricle. Occasionally the "Flint 
murmur" may be heard. 

Differentiate typhoid fever and remittent fever. 

In typhoid fever prodromes are present, such as loss of 
appetite, headache, diarrhea, evening fever, becoming more 
marked each succeeding night. On or about the 7th day the 
characteristic eruption appears, the typical tongue makes its 
appearance, the spleen is enlarged, and the dicrotic pulse is 



646 PRACTICE OF MEDICINE. 

found during the second week. The Widal and diazo reac- 
tions are present. Remittent fever may be present in many 
of these cases; there is, however, no Widal or diazo reac- 
tion, no dicrotic pulse, and the presence in the blood of the 
Plasmodium malarige will in all cases lead to a correct diag- 
nosis. 

Describe four peculiar appearances of the tongue and 
give their significance in diagnosis. 

A flabby, indented, swollen tongue, covered with a yellowish 
fur shows catarrhal gastritis. This tongue is also seen in 
smokers and drinkers, and occurs often in moderate fevers. 
A tongue which is red at the edges and tips and is coated pos- 
teriorly occurs in enteric fever. The "strawberry" or cat 
tongue, in which the papilla? are elevated and a slight grayish 
fur is seen, occurs in scarlet fever. Furrings which are small 
and limited indicate irritation from a rough tooth or inflam- 
mation of a tonsil. 

Differentiate acute rheumatism and periostitis. 

Acute rheumatism is characterized by redness, swelling and 
pain in the joints, by fever of a moderate range, by acid 
sweats and a constant tendency to inflammation of the serous 
membranes of the heart. Periostitis, as a rule, follows an 
injury; the pain is more localized and does not refer to the 
joints ; there are no acid sweats, and pus formation may occur, 
which is exceedingly rare in acute rheumatism. 

Differentiate neuritis from myalgia. 

In neuritis the pain is, as a rule, along the nerve trunks; 
trophic changes may occur. In myalgia pain is over the mus- 
cles; there is no constitutional disturbance; fever is entirely 
absent; pressure upon the affected area in myalgia gives re- 
lief; in neuralgia the pain is aggravated by pressure. 

Describe the symptoms of yellow fever. 

For 'convenience of description the disease is divided into 
three stages: The stage of onset, which generally lasts three 



PRACTICE OF MEDICINE. 647 

days ; the period of calm, which lasts from 12 to 24 hours ; and 
the period of collapse, the duration of which is indefinite. In 
the first stage there is headache, pain in the bones, nausea and 
vomiting, moderate fever, the pulse may be 80 to 100 in a min- 
ute, and becomes progressively slower as the disease advances, 
the urine is albuminous ; there may be even in this stage slight 
jaundice. These symptoms disappear more or less abruptly 
and give place to the stage of calm, in which all the previous 
symptoms disappear; and recovery from this stage may be 
uninterrupted. If this favorable event should not occur, the 
third stage is ushered in, with the appearance of marked jaun- 
dice, from which the disease receives its name. There may be 
hemorrhage from any of the internal organs, most frequently, 
however, from the stomach, the characteristic black vomit. 
The symptoms of the first stage are added to this. 

Give the diagnosis of gastric ulcer. 

The disease is most frequent in young anemic females. 
There is pain and tenderness on pressure in the region of the 
ensiform cartilage ; there is hematemesis and obstinate con- 
stipation. Examination of the gastric contents shows an 
excess of HC1. 

Give the symptoms resulting from paralysis of the 
phrenic nerve. 

This is a paralysis of the diaphragm, if the condition is bi- 
lateral; no movement is noted on the abdomen and epigas- 
trium; the hypochondrium is drawn in; marked dyspnea 
occurs upon the slightest exertion. There may be enlarge- 
ment of the chest. 

What is the significance of the patellar reflex as a sign 
of disease? 

Absence of the knee-jerk is caused by a lesion affecting any 
region of the reflex arc ; it is, therefore, lost in disease affect- 
ing either motor or sensory fibers or both, as in neuritis, in 
disease of the posterior roots or columns, as in Friedreich's 
ataxia. It may be absent in apoplexy, epilepsy, injury to the 



648 PRACTICE OF MEDICINE. 

cord and in meningitis; it is sometimes absent in diabetes, 
diphtheria and chorea. It is exaggerated in hemiplegia fol- 
lowing apoplexy, in the cerebral palsies of children, in general 
paralysis of the insane, also in hysteria, neurasthenia and 
strychnine poisoning. 

Differentiate epilepsy from hysteria. 

Epilepsy is often preceded by an aura, followed by complete 
loss of consciousness. There are at first tonic, followed by 
clonic, convulsions ; during the attack the pupils are dilated ; 
the patients often bite their tongue. In hysteria there is never 
complete loss of consciousness ; there is no regularity with 
regard to the convulsion ; it is most common in females be- 
tween the ages of 15 and 25 ; the pupils are irregular, hystero- 
genic zones are present, the patient never falls so that she 
may be injured. 

Differentiate neuritis and rheumatism. 

In neuritis the pain is commonly along the nerve trunks; 
trophic changes occur ; there may be foot-drop or wrist-drop ; 
fever is slight. In rheumatism there is redness, swelling and 
pain in the joints, acid sweats, frequent implication of the 
membranes of the heart, marked deposits of urates in the 
urine. 

Differentiate acute phthisis and capillary bronchitis. 

There is a form of acute pulmonary phthisis which is known 
as the broncho-pneumonic form, which can with the greatest 
difficulty only be differentiated from so-called capillary bron- 
chitis. The main points of difference would consist in the 
progressive emaciation, a family history of tuberculosis, the 
finding of tubercle bacilli in the sputum, and the appearance 
of the physical signs in the lungs. 

What are the clinical manifestations of biliary calculi? 

As long as the calculi remain quiescent in the gall-bladder 
no symptoms arise. It is only upon the passage of the gall- 
stones into the duct that the symptoms of hepatic colic arise, 



PRACTICE OF MEDICINE. 649 

which consist in great pain in the region of the liver, radiating 
toward the umbilicus and right shoulder-blade, nausea and 
vomiting and, after the passage of stones, jaundice, clay- 
colored stools and the appearance of biliary pigments in the 
urine. 

Differentiate empyema from pulmonary abscess. 

In pulmonary abscess there is a fever of a septic type, the 
physical signs of a cavity are commonly present, frequently 
expectoration of foul-smelling pus, which under the micro- 
scope shows elastic fibers. In such cases leukocytosis is pres- 
ent. In empyema there are the usual signs of pleural effusion. 
the temperature may range from 102° to 105°, displacement of 
the heart and the adjacent organs is common, local edema 
and redness of the skin are often present. 

Describe the diagnostic characteristics of the eruption 
of typhoid fever, smallpox and chicken=pox. 

The eruption of typhoid fever appears about the seventh 
day, consisting of slightly elevated, rose-colored spots, which 
disappear on pressure and appear again after the pressure is 
removed; they occur in crops, having a duration of from two 
to three days ; they appear commonly on the abdomen, chest, 
between the shoulder-blades, extremely rarely upon the face. 
The eruption of smallpox appears on the third day in the form 
of a macula, passing through the successive stages of vesicle, 
pustule, crust and scar. The pustule is umbilicated and has 
an inflammatory areola ; the eruption appears all over the 
body, especially on the exposed parts. The eruption of 
chicken-pox appears on the first day; it appears as a small 
reddish papule, which in a very few hours becomes a vesicle; 
the vesicle is thin and transparent. > 

Differentiate diphtheria from follicular tonsillitis. 

In diphtheria the exudate is found upon all parts of the 
posterior pharynx, uvula and tonsils. Around the exudate 
there is an inflamed areola. The exudate is removed with 
great difficulty, leaving a bleeding surface, the false mem- 



650 PRACTICE OF MEDICINE. 

brane rapidly reforming. Iu follicular tonsillitis the exudate 
is strictly limited to the crypts of the tonsils ; it is wiped away 
with ease, without leaving a bleeding surface, and it does not 
reform. The Klebs-Loffler bacillus is found only in the diph- 
theritic exudate. 

Differentiate acute enteritis from acute dysentery. 

In dysentery the important symptoms to be considered are 
tormina, tenesmus and stools composed of mucus and blood. 
These symptoms in acute enteritis do not occur in anything 
like the severity and constancy that they do in dysentery. 

Differentiate appendicitis from enteric fever. 

As a rule, appendicitis begins abruptly, with marked pain 
in the right iliac fossa over McBurney's point. There is con- 
stipation, tenderness, board-like rigidity, all this occurring, 
as a rule, within a few days. The onset of enteric fever is 
gradual, with prodromes of diarrhea, headache, characteristic 
tongue, appearance of the eruption about the seventh day, 
enlargement of the spleen, dicrotic pulse, Widal reaction. 

Differentiate acute pericarditis from acute endocarditis. 

In pericarditis there is pain in the pericardium. This, as 
a rule, is absent in endocarditis. In pericarditis there is a 
friction sound, which may be either systolic or diastolic, but 
as a rule, is not related to either. In endocarditis there is a 
murmur, which is either systolic, diastolic or presystolic; the 
murmur is transmitted, the friction sound is localized. The 
murmur is heard at the punctum maximum ; the friction sound 
is heard over the body of the heart and is nearer the ear. 

How would you diagnose a case of rickets? 

Sometime between the seventh month and second year of life 
the patient shows irritability, restlessness and some fever 
toward evening, dentition is delayed and gastro-intestinal 
disturbances follow; there is profuse sweating. The shape 
of the head is characteristic; it is rectangular, the face ap- 
pearing small in proportion to the skull, bone changes are 
noted, and the rachitic rosary appears. 



PRACTICE OF MEDICINE. 651 

Differentiate variola and varicella. 

In variola the eruption appears on the third day, preceded 
by marked constitutional symptoms. The eruption goes 
through the successive stages of macule, papule, vesicle, pus- 
tule, which is umbilicated and surrounded by an inflammatory 
areola, crust and scar. The eruption in varicella appears on 
the first day and is vesicular almost from the beginning. 
There are rarely marked constitutional phenomena, and the 
disease is essentially one of childhood. 

Differentiate apoplexy from uremic coma. 

This is often very difficult; however, the following points 
favor apoplexy: Profound coma, the face may be pale and 
cyanotic or flushed; respiration is stertorous and slow and 
may be of the Cheyne-Stokes type ; hard arteries, with a slow, 
hard, irregular, full pulse; the pupils are dilated or unequal 
and do not react to light ; conjugate deviation of the head may 
be present ; there is evidence of paralysis ; the skin is hot and 
dry ; the coma in uremia may be preceded by, or accompanied 
with, convulsions; the face may be pale and edematous; the 
pulse is slow and of high tension, showing either hypertrophy 
of the heart or sclerosis of the vessels ; there may be a urinous 
odor exhaling from the patient ; frequently there is edema of 
the feet ; albumin and casts are found in the urine ; albumi- 
nuric retinitis may be present. 

Differentiate unconsciousness from apoplexy, syncope 
and alcoholic intoxication. 

(Apoplexy see above.) In syncope the face is very pallid, 
the pulse is very weak, and the pupils are markedly dilated. 
In alcoholic coma the unconsciousness is rarely complete. The 
alcoholic odor of the breath is not diagnostic, as apoplexy and 
uremia may occur in persons that have been drinking. The 
pulse is at first rapid and full, later becoming small and fee- 
ble. The pupils are equal and often dilated. The skin is 
cool and moist and the temperature subnormal. 



652 PRACTICE OF MEDICINE. 

Differentiate cardiac hypertrophy from cardiac dilata= 
tion. 

In cardiac hypertrophy the apex-beat is displaced down- 
ward and to the left. The first sound of the heart is strong 
and booming. The pulse is slow and strong. In cardiac dila- 
tation the apex-beat is displaced to the right. It is diffused 
and feeble, the first sound being weak. The pulse is often 
rapid, irregular and weak. 

Differentiate Asiatic cholera from cholera morbus. 

This often presents great difficulties, especially in times of 
an epidemic of cholera; however, the finding of the comma 
bacillus will in all cases clear up the diagnosis. Rice water 
discharges are much more common in true cholera. In cholera 
morbus there is usually the history of an indiscretion in diet. 

Differentiate heat exhaustion from sunstroke. 

In heat exhaustion premonitory symptoms occur, such as 
dizziness, headache, nausea and vomiting. The respirations 
are increased in number, and the pulse is very rapid, 130-140 
per minute. Unconsciousness is not profound. The temper- 
ature may be normal or subnormal, or slight fever may be pres- 
ent. In sunstroke there may or may not be prodromes. The 
temperature is very high, from 106°^115°, or even higher. 
Dyspnea is marked, and the skin of the body is red and some- 
times even livid. The pupils are contracted and the pulse is 
very rapid. There is complete unconsciousness in which con- 
vulsions may occur. Cheyne-Stokes breathing may be present. 

Diagnosticate parenchymatous nephritis. 

The face is pale and edematous. The pulse is full and 
strong, showing some hypertrophy of the heart at first, al- 
though this is not nearly as common as in the interstitial 
variety. The urine is decreased in amount, of high specific 
gravity, high-colored, and contains large amounts of albumin 
and casts. Often there is also edema of the lower extremity. 

Differentiate aortic and mitral valvular diseases. 

In aortic disease the murmur is heard with the greatest in- 



PRACTICE OF MEDICINE. 653 

tensity at the aortic cartilage (second right costal cartilage) ; 
it is either transmitted to the neck, if it be systolic, or it is 
transmitted down the sternum, if the murmurs be diastolic in 
time. In aortic valvular disease there is always hypertrophy 
of the left ventricle. In mitral disease the murmur is heard 
at the apex. It is transmitted to the axilla and the angle of 
the scapula if the murmur be systolic in time. The presys- 
tolic murmur is not transmitted and is accompanied with a 
presystolic thrill. 

When is perforation in typhoid fever most likely to 
occur? 

Sometime in the course of the third week. 

Describe the essentially different sounds given by the 
thorax on percussion. 

Tympany is elicited over the trachea, resonance over the 
lungs, dulness over the heart. 

In what cases would the ophthalmoscope aid in diag= 
nosis? 

In disease of the arteries (retinal hemorrhages). In dis- 
ease of the kidney, in disease of the nervous system, syphilis, 
tobacco-poisoning, lead-poisoning, tubercular meningitis, dia- 
betes, etc. 

Differentiate in a general way between cerebrospinal 
fever and tubercular meningitis. 

The onset of tuberculosis is not so sudden as in cerebro- 
spinal meningitis ; the pains, hyperesthesia and retraction are 
less, and there are no eruptions. Retraction of the abdomen, 
irregular pulse and Cheyne-Stokes respiration are much more 
frequent. A pre-existing tuberculous lesion may be found, 
and the ophthalmoscope may reveal tubercles in the choroid. 

What does bronchial breathing indicate? 

This is heard normally when listening over the trachea. It 
is encountered over airless spaces in the lung tissue and over 
cavities. 



654 PRACTICE OF MEDICINE. 

In what diseases can we employ the microscope to ad= 
vantage as an aid in diagnosis? 

Principally in diseases of the blood and kidney. It is also 
necessary in the examination of all secretions and excretions 
for pathogenic organisms and parasites. 

Describe the physical signs of simple ascites and those 
of ovarian dropsy. 

In ascites, if the patient "be lying upon the back, the center 
of the abdomen is flat (provided the amount of fluid is not 
excessive), the lateral and dependent portions bulge. There 
will be tympany over the region of the umbilicus and flatness 
in the flanks. Fluctuation will be obtained. In dropsy due 
to ovarian disease the accumulation of the fluid is local (in 
the region of the ovary) ; it does not change with position 
of the patient. If the accumulation be great, the differential 
diagnosis is very difficult; vaginal examination must be made, 
and sometimes the character of the dropsy can only be deter- 
mined from the fluid withdrawn. 

Differentiate the early eruption of syphilis and measles. 

In syphilis there is the history of the chancre, and quite a 
period (six weeks) before the eruption appears. Coincident 
with the eruption there is inflammation of the throat (mucous 
patches) . There is rarely any fever. The eruption is copper- 
colored, and is not particularly prominent on the face. In 
measles there is marked fever from the onset, with severe 
catarrhal symptoms. The eruption does not appear before 
the fourth day, it occurs prominently on the face and rapidly 
.spreads all over the body, the catarrhal symptoms continuing. 

What are the methods of physical diagnosis or explora= 
tion? 

Inspection, palpation, mensuration, percussion, auscultation 
and succussion. 

Describe the symptoms of acute inflammatory arti= 
cular rheumatism. 

The disease, as a rule, begins with pain, swelling and red- 



PRACTICE OF MEDICINE. 655 

ness of one or more of the large joints. The joints implicated 
are symmetrical. There is moderate fever, 102°-103°, acid 
sweats and marked urates in the urine. There is a tendency 
to implication of the serous membranes of the heart. 

Give the etiology and describe the symptoms of idio= 
pathic erysipelas. 

It occurs at all seasons of the year and in all climates. It 
is most liable to occur in debilitated and cachectic persons 
and in the course of chronic pulmonary tuberculosis. The 
disease may occur in the puerperal state. The exciting 
cause is the streptococcus erysipelatis of Fehleisen. The dis- 
ease begins with a chill or chilliness, and is followed by the 
development of the eruption. There are gastro-intestinal 
symptoms or fever. The skin becomes irritated, itchy and 
swollen. There is heat, tension and burning in the part. 
The eruption shows decided elevation with a distinct, promi- 
nent margin, it is red or puffy in the center and glossy in 
appearance. Uncomplicated cases last from two to three 
weeks. 

- Mention the causes and describe the treatment of pri= 
mary lobar pneumonia. 

The exciting cause is the diplococcus or pneumococcus of 
Frankel. Exposure to cold and wet, alcohol, are said to be 
predisposing causes. The treatment of the disease consists 
in giving the preliminary purge, preferably calomel. Dover's 
powder or a hypodermic injection of morphine to relieve the 
pleural pain, remedies to sustain the heart and respiration, 
such as alcohol and strychnine, are useful. Ammonium car- 
bonate and ammonium chloride are also of value. 

Describe the treatment of hydrothorax. 

Purges, diaphoretics and diuretics are of value. If these 
remedies do not relieve the condition the aspirator must be 
resorted to. 



656 PRACTICE OF MEDICINE. 

State your treatment, including diet, of typhoid fever. 

If the patient be seen before the tenth day of the disease, 
a calomel purge should be administered. The systematic cold 
bath of Brand is a favorite method of treatment. Alcohol 
and strychnine are valuable adjuncts to sustain the circula- 
tion. The diet should be absolutely liquid. Water plenti- 
fully, milk, liquid peptonoids are commonly employed. No 
solid nor semi-solid food should be administered before the 
evening temperature has been normal for at least one week. ■ 

Describe the treatment of diabetes mellitus. 

Diet is most important. No starches or sugars should be 
given. The diet should consist in the fresh green vegetables, 
meat, fish. No alcoholic or malt liquors should be em- 
ployed. The generally accepted treatment is by some form 
of opium, codeine being most often employed. 

Give the symptoms and treatment of tetanus. 

The prominent symptoms are the occurrence and recurrence, 
at varying intervals, of tonic spasm of greater or lesser inten- 
sity in the voluntary muscles. The spasm is usually first 
noticed in the neck, which is soon followed by spasm of the 
muscles of the jaw, with inability to open the mouth. There 
is pain, which, however, is not severe. Occasionally the body 
arches backward, a condition known as opisthotonos. There 
is usually fever of about 101°, but after prolonged spasm 
hyperpyrexia may occur. The urine is scanty, extremely 
toxic and often contains albumin. Profuse sweating is a 
prominent symptom. The treatment consists in the endeavor 
to administer nutriment, and rectal injections should be re- 
sorted to. Chloral is of value because it produces sleep and 
sometimes relaxes spasm. Antitetanic serum is of value in 
some cases. The wound should be thoroughly cleansed and 
treated antiseptically. 

What is the most common cause of tabes dorsalis? 

Syphilis. 



PRACTICE OF MEDICINE. 657 

How should acute coryza be treated? 

Acute coryza should be treated by cleansing the nose with a 
mild antiseptic solution; a weak solution of cocaine is also of 
value. Dover's powder is also recommended internally. 

Describe the treatment of pleurisy with effusion. 

The common measures administered to absorb fluid, such as 
purges, diaphoretics and diurectis, should be resorted to. If 
these fail the aspirator may be used. 

What is the period of incubation in variola and vaccinia? 

The period of incubation of variola is from ten to thirteen 
days. The period of incubation in vaccina varies from three 
to seven days, depending upon whether humanized or bovine 
virus is used. 

What are the symptoms of hepatic abscess? In what 
climate is hepatic abscess most likely to occur? 

The symptoms of hepatic abscess are an enlarged and tender 
liver, with jaundice, anemia and wasting. The clinical mani- 
festations vary, and large abscesses may be present without 
marked disturbance. Occasionally fluctuation may be de- 
tected in the liver. There may be pain of a throbbing char- 
acter. Occasionally all the phenomena of sepsis are present, 
chills, fever and sweating. The disease is most common in 
hot climates. 

How may pleuritis in its early stages be differentiated 
from intercostal neuralgia? 

In pleuritis there is pain, which is especially aggravated by 
breathing. In intercostal neuralgia the pain is over the exit 
of the intercostal nerves. It is increased by pressure. In 
pleuritis the pain is diminished by pressure. The pain is not 
aggravated in intercostal neuralgia by deep breathing. In 
pleurisy there is a friction sound, which does not occur in 
intercostal neuralgia. Frequently intercostal neuralgia is 
accompanied by the development of herpes zoster. 
42 



658 PRACTICE OF MEDICINE. 

How many and what are the stages of malarial inter= 
mittent fever? 

There are three stages : The stage of chill, the stage of fever, 
and the sweating stage. 

Mention the eruptive fevers. 

Scarlet fever, measles, German or French measles or rubella, 
variola, varicella and erysipelas. 

Describe the treatment of intermittent fever. 

The treatment of intermittent fever consists in the admin- 
istration of quinine in sufficient doses to destroy the Plasmo- 
dium of malaria. From 10 to 20 grains a day for an adult is 
sufficient for this purpose. 

Give the etiology and outline the treatment for acute 
gastritis. 

If the majority of instances the condition is due to irritants, 
either thermic or chemical, that come in contact with the 
mucous membrane of the stomach, producing an acute inflam- 
mation. Food either too hot or too cold, spices, drugs and 
poisons may have this influence on the mucous membrane. 
The treatment consists in the administration of a purge, such 
as calomel or castor oil. The diet should be restricted for a 
while. In severe cases it is necessary to produce vomiting. 
Lavage is useful. Drugs are scarcely ever necessary. 

Describe the symptoms and treatment of chronic hydro= 
cephalus in children. 

The symptoms of congenital hydrocephalus are difficulty in 
the movements of the child on account of the weight of the 
head. As a rule there is impairment of intellect. The head 
is often enormous in size. There may be headache and dim- 
ness of vision, and the gait may become irregular. The pulse 
is usually slow. Medical treatment is of no avail in this con- 
dition. Operative methods are advised by some authorities. 

Define rubeola and describe its symptoms. 

Rubeola is an acute, infectious, contagious disease charac- 



PRACTICE OF MEDICINE. 659 

terized by marked catarrhal symptoms, especially of the res- 
piratory tract, with a characteristic eruption occurring on the 
fourth day. The disease may begin with a chill, followed by 
fever that may reach 103° F. or higher, with marked catarrhal 
symptoms from the onset. There is injected conjunctiva, 
lachrymation, photophobia, coryza, and some cough. Rales 
are heard in the chest. Koplik's sign may appear about this 
time. On the fourth day the eruption appears, which consists 
of rose-red or brownish maculo-papular points raised above 
the skin, with intervening healthy skin, often arranged in 
crescentic shape. The eruption remains at its height for about 
four days. The catarrhal symptoms continue. About the 
eighth day of the disease the eruption begins to fade. A fine 
desquamation occurs. In the absence of complications the 
disease lasts about twelve days. 

Describe the symptoms and treatment of gangrene of 
the lung. 

Cough accompanied by expectoration, which is abundant, 
thin and foul-smelling, should call attention to gangrene of 
the lung. Fever is always present. There is often hemop- 
tysis. Microscopically the sputum contains leukocytes, shreds 
of lung tissue, especially elastic fibers, fat crystals and bac- 
teria. Upon percussion over the affected area dulness is pres- 
ent. Upon auscultation, bronchial breathing and, if excava- 
tion occurs, signs of a cavity are present. The treatment is 
supportive. 

Describe the symptoms of tubercular meningitis. 

The course of the disease is usually divided into a pro- 
dromal stage, a period of excitement and a period of paralysis. 
In the prodromal stage the child becomes irritable and rest- 
less, there is anorexia, heachache, pain in the limbs, accom- 
panied by nausea and obstinate vomiting. The second 
stage is marked by an aggravation of the symptoms just 
enumerated, with fever. The headache becomes intense, and 
is usually general. The hydrocephalic cry is usually present. 



660 PRACTICE OF MEDICINE. 

Obstinate constipation is characteristic. There is a rapid 
pulse, which may be from 120 to 160 per minute ; the abdomen 
is prominent ; nervous symptoms are present, most frequently 
delirium. The pupils are contracted, and strabismus may 
occur. There is marked cutaneous hyperesthesia. Convul- 
sive movements are common. This period lasts for a week or 
ten days and is followed by the stage of paralysis. The fever 
becomes higher, often reaching 105° or 106°. Spasmodic 
contractions, with tremor and twitching of the tendons and 
muscles, with local paralysis occur. The third nerve is most 
frequently involved, causing ptosis. The duration of the dis- 
ease is variable, lasting about three weeks. When the disease 
occurs in adults it may be prolonged to three or four months. 
Leukocytosis is present throughout the course of the disease. 

What should be done for hemoptysis occurring in the 
course of phthisis? 

Absolute quiet is essential ; food and drink should be stopped 
for a while; ice-bags may be applied over the chest; the ad- 
ministration of oipium in some form is generally advised. 

Give the symptoms of epidemic influenza. 

The disease occurs suddenly, usually with a chill and marked 
fever, 103° -105°, with catarrhal symptoms, such as sneezing, 
coughing, etc. There is headache, usually frontal or behind 
the eyes, or at the root of the nose, pain in the limbs and in 
the bones. There is marked prostration, out of proportion to 
all the other phenomena. There is a constant tendency to 
complications resulting from inflammation of the respiratory 
or gastro-intestinal mucous membrane. There may be nau- 
sea and diarrhea. Uncomplicated cases last from a week to 
ten days. 

What is hemoptysis? 

Bleeding from the lungs. 

Give the physical signs of pleuritic effusion. 

On inspection there may be slight bulging. The apex-beat 



PRACTICE OF MEDICINE. 661 

of the heart is seen to be displaced. Upon palpation there is 
decreased vocal fremitus. Upon percussion there is flatness 
over the affected area. Upon auscultation the breath-sounds 
are absent, and vocal resonance cannot be obtained over the 
affected area. 

Describe the natural heart sounds. 

Two distinct sounds are encountered: The systolic or first 
sound, and the diastolic or second sound. They are separated 
from each other by a short pause, a long pause occurring 
between the second and first sound. The first sound is due to 
the contraction of the ventricle, the rush of blood and the 
closure of the auriculo-ventricular valve. It is long, low and 
booming in character. The second sound is due to the closure 
of the semilunar valve, and is short and valvular. The first 
sound is best heard at the apex, the second sound at the base 
of the heart. 

On what day does the rash usually appear in scarlatina? 

At the end of the first or beginning of the second day. 
What are the symptoms of delirium tremens? 

The prodromes consist of nervousness, restlessness and ano- 
rexia. As a rule there is insomnia. A tremor occurs which 
affects the lips, tongue and limbs. Delirium soon develops, 
which is active and constantly changing. The skin is moist 
and the expression is anxious. The pupils are dilated. The 
temperature is subfebrile, the pulse soft and rapid. The 
tongue is covered with a thick fur, and there is sometimes 
nausea and vomiting. 

What are the clinical features of cerebrospinal fever? 

The onset is sudden, beginning with intense headache, stiff- 
ness in the muscles of the back of the neck, nausea and vomit- 
ing. The attack may begin with a chill. Delirium and stupor 
commonly occur. There is marked alteration of sensation. 
The fever varies from 101°-105° or more. Kernig's sign is 
present. Herpes is very common. Other eruptions also 



662 PRACTICE OF MEDICINE. 

occur, such as erythema, urticaria and petechige. Arthritis 
may be present. The urine is scanty and may contain 
albumin. 

Diagnose varioloid. 

The disease begins with a chill, followed by fever of about 
103°. There is nausea and vomiting, pain in the head and 
back. The eruption occurs earlier than in variola, usually in 
the course of the second day. It is never so copious. The 
evolution of the pox is arrested in the vesicular stage. There 
is no secondary fever, as there is no pus to absorb. 

Give the symptoms of acute myelitis. 

Paralysis of motion, which comes on rapidly, with complete 
loss of sensation below the site of the lesion, and paralysis of 
the sphincters are the important symptoms. Bed-sores usually 
occur. There is some rise in temperature. Convulsions may 
occur. Reactions of degeneration are not present. The re- 
flexes are exaggerated when the lesion is above the lumbar 
region, and ankle clonus may be elicited. Loss of sensation 
is complete. 

What diseases produce conditions of the skin which are 
of general diagnostic value? 

The eruptive diseases, yellow fever, diseases of the liver, 
purpura, Addison's disease and melanotic cancer. 

What would auscultation and percussion reveal in a case 
of congestion of the lung? 

Auscultation would reveal small moist rales, with broncho- 
vesicular breathing; percussion may reveal impairment of 
resonance. 

What are the physical signs of stenosis of the mitral 
valve? 

A presystolic murmur heard at or near the apex, which is 
not transmitted, a presystolic thrill and a rapid, irregular, 
feeble pulse. 



PRACTICE OF MEDICINE. 663 

Describe the features of a case which would lead you to 
diagnose acute appendicitis. 

Marked tenderness and pain in the right iliac fossa, espe- 
cially over McBurney's point; rigidity upon the affected side; 
nausea and vomiting, and marked constipation. 

What does the urine reveal as to color, specific gravity, 
quantity voided, abnormal constituents, etc, in a typical 
case of diabetes mellitus? 

The color is pale yellow with a slight greenish cast ; the spe- 
cific gravity is high, 1030 or over; the quantity voided is usu- 
ally large, five quarts or more in twenty-four hours; the 
abnormal constituents consist in the presence of glucose; 
occasionally there is also albumin. 

State the sex and period of life to which chlorosis is 
confined. 

It is common in the female sex, rarely occuring in the male. 
It is usually at the age of puberty. 

What are the grades of temperature which come under 
observation in the sick? 

The temperature of collapse is below 96° ; subnormal tem- 
perature is from 96°-97.5° ; normal temperature is 98.6° ; a 
subfebrile temperature is from 99.5° to 101° ; moderate fever 
from 101° to 103°; high fever from 103° to 105°; hyper- 
pyrexia above 105.5°. 

Give the most frequent causes of pericarditis. 

The most frequent causes are rheumatic fever, scarlet fever, 
diphtheria, septicemia and trauma. 

Give the symptoms of an ordinary case of scarlet fever. 

The disease begins suddenly, with chill or a convulsion. 
There is nausea and vomiting, high temperature, rapid pulse 
and marked angina. There is enlargement of the lymphatics 
at the angle of the jaw. At the end of the first or beginning 
of the second day an eruption appears all over the body, which 



664 PRACTICE OF MEDICINE. 

has the color of a boiled lobster. The eruption lasts four to 
five days and disappears by desquamation. Postscarlatinal 
nephritis is a frequent complication. 

Describe an attack of acute articular rheumatism. 

The disease begins suddenly, with fever of about 102°-103°. 
There is pain, tenderness, swelling and redness in one or more 
of the large joints. Occasionally prodromes are present. 
There may be a preceding tonsillitis or pharyngitis. The 
involvement of the joints is symmetrical. The pulse is accel- 
erated from 100 to 110 per minute, the urine is high-colored, 
scanty in amount, specific gravity from 1025 to 1040, contain- 
ing an abundance of phosphates and urates, albumin being 
rarely present. The saliva is strongly acid. Copious acid 
sweats occur. Skin eruptions are common, such as urticaria 
and erythema. 

Give the differential diagnosis between cerebrospinal 
meningitis and typhoid fever. 

In the first week of the disease the diagnosis is often diffi- 
cult. Later in enteric fever the characteristic eruption ap- 
pears, the spleen enlarges, the pulse becomes dicrotic, the 
nervous symptoms are not prominent until the beginning or 
toward the end of the second week, the headache disappears 
at the end of the first week, the Widal reaction is present. 
In enteric fever the onset is rarely sudden • there are marked 
prodromes, such as headache, epistaxis; vomiting is very in- 
frequent; the temperature curve in enteric fever is charac- 
teristic, rising step-like in the first week, being subcontinuous 
in the second, remittent in the third and intermittent in the 
fourth week. The onset in cerebrospinal fever is sudden, 
with chill or convulsion ; marked rigidity of the muscles of the 
back of the neck; violent headache and marked vomiting of 
the cerebral type. Herpes is common. The temperature is 
not characteristic, and the nervous symptoms are much more 
prominent than in enteric fever. 

What are the physical signs of pulmonary solidification? 

Upon palpation there is increased vocal fremitus. Upon 



PRACTICE OF MEDICINE. 665 

percussion there is dulness, and upon auscultation there is 
bronchial breathing. There may be rales. 

Differentiate catarrhal from croupous pneumonia. 

Catarrhal pneumonia is a disease secondary to bronchitis. 
Croupous pneumonia occurs suddenly, with marked chill, high 
temperature. In croupous pneumonia there is marked pain 
in the side, cough, anxious expression of the face, flush upon 
the cheeks, herpes, rusty sputum, and the disease terminates 
by crisis, usually upon one of the odd days of the disease, 
fifth, seventh or ninth day. Broncho-pneumonia occurs most 
commonly at the extremes of age. The disease is longer in 
duration, terminating by lysis. Upon physical examination 
in broncho-pneumonia there are scattered areas through both 
lungs, over which may be detected subcrepitant rales and 
dulness. Croupous pneumonia is, as a rule, a unilateral dis- 
ease affecting the base of the lung. The crepitant rale, which 
occurs in the first stage, disappears in the second stage and 
reappears in the third stage as crepitus redux, is charac- 
teristic. 

Give the general symptoms of cerebral hemorrhage. 

The onset is sudden, with loss of consciousness, a rapid 
development of hemiplegia, conjugate deviation of the head 
and eyes, usually normal temperature, full, bounding pulse 
and irregular pupils. There may be Cheyne-Stokes respi- 
ration. 

What condition of the blood is generally prominent in 
all forms of rheumatism? 

There is marked anemia. The red bloodcells may be re- 
duced one-half or more in number. The hemoglobin may be 
reduced to fifty per cent., and leukocytosis occurs. 

What adventitious sounds are usually discovered by 
auscultation in catarrhal pneumonia? 

Rales, usually of the subcrepitant variety, large mucous 
rales and broncho-vesicular breathing. 



666 PRACTICE OF MEDICINE. 

How are the lymphatic glands involved in scarlatina? 

The lymphatic glands at the angle of the jaw and of the 
neck are usually enlarged, sometimes greatly, so that they 
form what is known as the collar of brawn. 

Give the physical signs of the second stage of acute 
lobar pneumonia. 

There is dulness on percussion, bronchial breathing on aus- 
cultation. 

Give the topographical outlines of the liver as revealed 
by percussion when the patient is in the recumbent posi= 
tion. 

Anteriorly liver dulness begins in the mammillary line at 
the sixth rib, in the axillary line at the eighth rib, and in the 
scapular line posteriorly at the tenth rib. It extends from 
all these points to the lowest border of the costal cartilages. 

At what point does auscultation best reveal the sound 
of the mitral valves and of the aortic valves? 

The sound of the mitral valve is best heard at the apex of 
the heart. The sound of the aortic valve is best heard at the 
second right costal cartilage near the sternum. 

Make a diagnosis of locomotor ataxia. 

The disease is commonly divided into three stages : The pre- 
ataxic, the ataxic 'and the paralytic stage. The pre-ataxic 
stage is characterized by lightning pains, most often in the 
lower extremities, by ocular phenomena such as the Argyll- 
Robertson pupil, which is a contracted pupil reacting to 
accommodation but not to light, and by the use of the patellar 
tendon-reflex. In the second stage the ataxic gait occurs ; the 
patient cannot stand with his feet in juxtaposition with his 
eyes closed. The symptoms of the pre-ataxic stage continue 
in this stage. The paralytic stage is characterized at first by 
loss of control of the sphincters and by paralysis. 

Give the symptoms of acute spinal meningitis. 

The disease usually begins with chill and a temperature of 



PRACTICE OF MEDICINE. 667 

the aseptic type. There is severe pain in the back, increased 
by motion, radiating into the extremities ; rigidity of the mus- 
cles occurs. Hyperesthesia is general. The reflexes are ex- 
aggerated, and ankle clonus is pronounced. There may be 
retention of urine and feces from paralysis of the sphincters. 

What is the period of desquamation in scarlet fever? 

The period of desquamation in scarlet fever usually occurs 
after the appearance of the eruption, or when the eruption 
has been prominent for about four or five days. It may last 
from several days to several weeks or more. The desquama- 
tion is usually in large scales. 

Define lithemia. 

A condition due to a disturbance of metabolism, character- 
ized by an excess of uric acid in the blood, and clinically by 
various digestive, nervous and circulatory phenomena. 

What are hemic murmurs as applied to the heart, and 
what is their cause? 

It is commonly believed that hemic murmurs are due to an 
alteration in the constituents of the blood, such as occurs in 
chlorosis or in other forms of anemia. These murmurs are 
systolic in time, soft, and heard at the left base of the heart. 

— Make a general diagnosis of icterus. 

Jaundice is characterized by a yellowish discoloration of 
the skin 'and of the conjunctiva. There is itching of the skin, 
slow pulse, the appearance of bile pigment in the urine and 
clay-colored stools. 

Why is dyspnea caused by disorganization of the mitral 
valves? 

This is due largely to the fact that, when rupture of com- 
pensation occurs, the right heart, and hence the pulmonary 
circuit, is interfered with. 

Describe a typical case of laryngismus stridulus. 

The disease comes on abruptly, the child being attacked 



868 PRACTICE OF MEDICINE. 

most often at night with shortness of breath, followed by clos- 
ure of the glottis, which may remain closed from several sec- 
onds to twenty or thirty. During this time cyanosis may be 
a prominent feature. This is followed by relaxation of the 
spasm giving rise to high-pitched inspiration. Convulsions 
may occur, and are apt to be very severe. 

Describe a typical case of typhus fever. 

The disease begins suddenly, with marked chill and high 
temperature. There is nausea, vomiting and epigastric pain. 
The pulse^ is rapid, hard and not easily compressible. Ver- 
tigo and delirium soon set in. The face is reddened, the pupils 
are contracted and the conjunctiva injected. The tongue is 
coated. The liver and spleen are painful upon palpation 
and are somewhat enlarged. Delirium and convulsions are 
common. Constipation is marked throughout the course of 
the disease. On or about the fifth, day an eruption occurs, 
which, in its early appearance, closely resembles measles. It 
occurs all over the body except the face. This eruption after- 
ward becomes petechial. Another eruption is characteristic, 
which consists of marbling or mottling of the skin. On or 
about the fourteenth day of the disease crisis occurs. 

What is the significance of prolonged expiration? 

When inflammatory exudates occur in the bronchial tubes 
the expiratory murmur equals and occasionally is longer than 
the inspiratory murmur. When this sign is localized to the 
apices it is indicative of incipient tubercular disease. It fur- 
ther occurs in bronchial asthma and in chronic pulmonary 
emphysema. 

What age and sex are most subject to chorea? 

It is a disease of childhood, most common between the fifth 
and fifteenth years; much more common in the female than in 
the male sex. 

What is understood by an exanthernatous fever? 

A fever in which a characteristic eruption occurs. 



PRACTICE OF MEDICINE. 669 

What parts of the brain are most liable to hemorrhage? 

The parts supplied by the middle cerebral artery. 

Describe the morbid states associated with asthma. 

They are chronic bronchitis and chronic pulmonary emphy- 
sema. 

What are the general or constitutional symptoms of 
diphtheria? 

The onset of the disease is rapid, the early symptoms being 
discomfort and weakness, with headache. There is moderate 
fever. Pain on swallowing is often the first symptom. Upon 
examination of the throat the characteristic exudate is seen. 

What are the physical signs of aortic regurgitation? 

Upon inspection the apex of the heart is found displaced 
downward and to the left. The impulse is seen to be forcible, 
indicating great hypertrophy of the left ventricle. Palpation 
confirms this. Upon auscultation a diastolic murmur is noted 
at the second right costal cartilage, transmitted down the 
sternum. The Flint murmur may be present. The pulse is 
characteristic, being known as Corrigan, receding or water- 
hammer pulse. 

On what day does the rash usually appear in measles? 

On the fourth day. 

What is progressive pernicious anemia? 

This is a primary anemia, characterized by a marked de- 
crease in the number of red bloodcells, by fatty degeneration 
of the heart, liver and kidneys, and by a peculiar lemon-yellow 
discoloration of the skin. 

What is Asiatic cholera? 

A specific disease, due to the comma bacillus of Koch, pre- 
vailing endemically in some parts of the world, and occasion- 
ally becoming epidemic, characterized by vomiting, purging,, 
muscular cramp and high mortality. 



670 PRACTICE OF MEDICINE. 

Enumerate the points of diagnostic value in a case of 
chronic interstitial nephritis. 

Hypertrophy of the heart and arteriosclerosis, albuminuric 
retinitis, headache, the passage of large amounts of urine of 
low specific gravity, 1004 to 1006, traces of albumin and often 
without albumin, and the presence of tube casts. 

Name a medicine which affects the urine as to color and 
odor. 

Turpentine. 

What cardiac lesions are likely to accompany or to foI= 
low acute articular rheumatism? And how may they be 
recognized by the aid of the stethoscope? 

Pericarditis and endocarditis. In endocarditis a murmur 
will be developed ; in pericarditis a friction sound is heard. 

How may rheumatism affect the respiratory organs? 

Pleurisy with or without effusion may occur in the course 
of rheumatic fever. 

What is the usual reaction of the urine in (a) chronic 
cystitis, (b) acute articular rheumatism? 

In chronic cystitis the reaction is usually alkaline ; in acute 
articular rheumatism markedly acid. 

What is the diagnostic significance of dropsy? 

Dropsy is an accumulation of watery fluid in one or more 
of the serous cavities or in the subcutaneous tissues. It is due 
to venous obstruction, to a toxemic condition of the blood, to 
the effects of inflammation upon the neighboring circulation, 
to vasomotor causes relating to disease of the nervous system, 
to lymphatic obstruction, and it occurs in a condition known 
as idiopathic or essential edema. 

Define a puerile murmur and give its causes. 

This form of breathing is normal in infants and children. 
It diminishes in intensity up to the age of twelve years. It 
closely resembles broncho-vesicular breathing. However, the 



PRACTICE OF MEDICINE. 671 

ratio between the length of inspiration and expiration is 
always longer. It is occasionally heard in dyspnea, especially 
from disease of the heart. It also occurs in what is known 
as compensatory breathing over one lung w T hen there is disease 
of the opposite lung, or in the portion of one lung when it is 
affected by disease in another part. 

Differentiate between sibilant and sonorous rales. 

Sibilant rales are high-pitched, whistling rales, and occur 
in the smaller bronchial tubes. Sonorous rales are low- 
pitched, snoring in character, and they occur in the larger 
bronchial tubes. 

Name the leading rational and physical signs of chronic 
bronchitis. 

The important sign of chronic bronchitis is cough, with or 
without expectoration. After chronic bronchitis has existed 
for some time, emphysema frequently occurs, and also bronchi- 
ectasis. The physical signs which belong to chronic bron- 
chitis are, particularly, rales, which are dry rales if there be 
no expectoration, and moist rales if expectoration be profuse. 

Differentiate between pulmonary edema and pneumo= 
nitis. 

Pulmonary edema is usually a secondary disease. There is 
marked dyspnea, urgent and troublesome cough, large num- 
bers of moist rales of all sizes are heard, particularly at the 
base. In pneumonitis there is the onset, with chill, high tem- 
perature, rusty sputum, and the important physical signs, 
which consists in crepitant rales, followed by bronchial breath- 
ing, and the crepitus redux. The termination is by crisis. 

In what conditions does bronchial breathing take the 
place of vesicular breathing? 

Bronchial breathing is encountered over airless spaces in 
the lung tissues and over cavities. Only pulmonary tissues 
containing air have the property of changing into the vesi- 
cular murmur the bronchial sound as it passes through the 
trachea and bronchi. 



672 PRACTICE OF MEDICINE. 

What is the character of the fever curve in chronic 
tuberculosis? 

As a rule it is intermittent in character. Occasionally, 
however, the inverse temperature curve is seen. 

What are the physical signs in the first stage of pneu= 
monic fever? 

On inspection there is increased breathing; palpation may 
detect friction fremitus from the associated pleurisy. On 
percussion there is impairment of resonance, and on auscul- 
tation the crepitant rale is found to be present. 

Relate the history of a case of progressive muscular 
atrophy. 

The early symptoms are pain in the arm and shoulder, with 
numbness and a feeling of exhaustion; next atrophy is no- 
ticed, as a rule, in one hand. The wasting usually extends, 
and the muscles supplied by the ulnar nerve are, as a rule, 
most affected. The motion of the fingers becomes impaired, 
and the wasting gradually passes up from the forearm to the* 
arm and shoulder. Both flexors and extensors are affected. 
The other hand usually shows the same process within two to 
ten months. Sometimes the muscles of the shoulder are first 
affected, next the muscles of the back, hip and thigh are in- 
volved. It is rare for the muscles of the legs to be attacked. 
There is paralysis and fibrillary twitching. The reflexes are 
lost early. Reactions of degeneration set in later. One or 
both sides of the face may be affected. The sphincters do 
not share in this process. 

Describe alcoholism and some of its effects. 

As a rule, the onset is insidious, the symptoms consisting in 
fatigue, unwillingness to work and loss of energy. There is 
malaise, headache, general and mental depression, loss of sleep 
and tremor of the hands, lips and tongue. The tremor at first 
may be controlled. As the condition advances these symptoms 
become more manifest. The skin becomes flabby, the face shows. 



PRACTICE OF MEDICINE. 673 

venous congestion, and acne may show itself about the nose. 
Symptoms of gastric catarrh are present as a rule. The 
tongue is flabby and furred, and the tremor is marked when 
the tongue is protruded. Leukoplakia may occur, especially 
in males. The breath is fetid, and there is great thirst. 
Often there is disgust for food, especially in the morning, and 
this is aggravated by the early morning nausea and vomiting. 
Insomnia is an early and almost constant symptom, and if the 
patient sleep at all, he is disturbed by bad dreams. Peri- 
pheral neuritis may develop. The will and intellectual facul- 
ties are greatly impaired, and there is perversion of the moral 
tendencies. The resistance of the body becomes lessened, so 
that drinkers readily succumb to the acute infectious diseases. 

What is the diagnostic significance of Cheyne=Stokes 
respiration? 

This form of respiration is very likely to be observed in 
disease of the brain, from disturbances of the circulation or 
from toxic conditions. 

— State where topographically mitral and tricuspid mur= 
murs are most distinctly heard. 

The mitral murmur is heard at or near the apex. The tri- 
cuspid murmur is heard a little to the right of the ensiform 
cartilage. 

Enumerate the diagnostic sounds in a diseased respi= 
ratory apparatus. 

There may be moist or dry rales, crepitant rales, friction 
sounds, bronchial breathing, broncho-vesicular breathing or 
cavernous breathing. 

In what conditions does sub=normal temperature occur? 

This occurs in diabetes, nryxederaa, chronic cardiac, renal 
and hepatic disease, and in many forms of insanity. It is 
also common in internal malignant growth. It frequently 
occurs after the defervescence in some of the specific fevers. 
It occurs in the stage of collapse in cholera. 
43 



674 PRACTICE OF MEDICINE. 

How does paralysis of the third nerve affect the eye? 

There may De ptosis, slight exopthalmus, external stra- 
bismus, diplopia and a dilated pupil which reacts neither to 
accommodation nor to light. 

Give the causes and clinical features of purpura sim= 
plex. 

This condition occurs in many diseases. It is characterized 
by the extravasation of blood into the skin, mucous membranes 
and internal organs, and sometimes by free hemorrhage from 
mucous membranes. The alterations in the composition of 
the blood in purpura are usually those of symptomatic ane- 
mia from hemorrhage. Purpura simplex is most usually 
met with in children. It is a mild condition, accompanied 
with purpuric spots, upon the extremities, and sometimes 
upon the trunk and arms, with impairment of the appetite 
and diarrhea. 

Make a diagnosis of cerebral tumor. 

The characteristic symptoms consist in headache, optic 
atrophy, sensory disturbances, convulsions, vomiting, vertigo 
and bradycardia. The headache is almost constant, and in- 
creases in severity as the disease advances. It may often be 
diffuse, occupying the entire skull. Double optic neuritis is 
very frequent. The temperature is usually normal or sub- 
normal. If, however, the tumor be situated in the pons or 
medulla ' there may be hyperpyrexia. Occasionally there is 
dyspnea, and also Cheyne-Stokes respiration. Yawning and 
hiccough occur. 

Describe the skin appearances in (a) rubeola, (b) ru= 
bella, (c) scarlatina and (d) vericella. 

(a) In rubeola the eruption appears upon the fourth day. 
It is maculo-papular and coarse. It appears all over the body, 
and is particularly marked upon the face. It is sometimes 
arranged in crescentic form. It disappears by fine desqua- 
mation, (b) In rubella the eruption occurs upon the first day 



PRACTICE OF MEDICINE. 675 

irregularly over the face, neck, chest, body and limbs. It is 
a multiform eruption, and may resemble erythema, urticaria, 
and in some cases even measles and scarlet fever. It may be 
confluent or diffuse, and usually lasts from two to four days. 
Desquamation occurs in fine scales, (c) In scarlatina the 
■eruption appears at the end of the first day or beginning of 
the second day. It is a bright scarlet eruption, being a true 
inflammation of the skin. It disappears by desquamation, 
which is often in large scales, an entire cast of a hand or foot 
coming away, (d) The eruption in varicella appears upon 
the first day, the exanthem showing itself as small reddish 
points or papules, which in a few hours become vesicles. The 
eruption is slightly elevated above the skin, rather than hav- 
ing the appearance of being under the skin. The vesicles are 
thin and transparent, and from Vs to % of an inch in diam- 
eter. The contents are at first clear and transparent. As a 
rule there is no areola. In the course of a few hours the vesi- 
cle becomes milky, and begins to shrivel. The pox may appear 
upon the face, neck, scalp, and some parts of the trunk. 

In what diseases may blood be expectorated? 

As a rule it occurs in chronic pulmonary tuberculosis. It 
sometimes occurs in croupous pneumonia. It may result from 
cancer of the lungs, from abscess of the lung, from bronchi- 
ectasis, ulcerative lesions of the bronchi and frequently in dis- 
ease of the mitral valve. It may occur from aortic aneurysm. 
Malignant disease and parasites of the lung also give rise to 
it. Vicarious hemorrhage. It may occur in the hemorrhagic 
diathesis, in purpura and trauma of the chest wall. 

Give the period of incubation and of eruption of the 
exanthemata. 

The period of incubation in scarlet fever is from four to 
seven days. The eruption occurs at the end of the first or 
beginning of the second day. The period of incubation in 
measles is about ten days. The eruption occurs on the fourth 
day. The period of incubation of rubella is about eighteen 



676 PRACTICE OF MEDICINE. 

days. The eruption appears upon the first day. The period 
of incubation in variola is from ten to thirteen days. The 
eruption appears upon the third day. The period of incu- 
bation of varicella is from ten to fifteen days. The eruption 
appears upon the first day. 

Make a differential diagnosis between renal colic and 
hepatic colic. 

The pain in biliary colic radiates over the upper half of the 
abdomen toward the right shoulder. There is tenderness over 
the gall-bladder. The pain in renal colic radiates less over 
the abdomen, but is marked down the ureter to the testicles 
and to the head of the penis, often irritating the rectum. 
There is tenderness over the kidney and in the lumbar region. 
In biliary colic the vomiting is pronounced and persistent. 
In renal colic vomiting may be present, but is never persistent. 
In biliary colic there are no symptoms relating to the bladder 
or testicle. In renal colic these symptoms are marked. The 
urine may contain bile in biliary colic. In renal colic the 
urine may contain blood and mucus. Jaundice is present in 
bliary colic, and entirely absent in renal colic. 

Mention and describe, in regard to the feces, abnormal 
conditions that are of diagnostic value. 

Large quantities of mucus may be present in the evacua- 
tions, showing a catarrhal condition of the mucous membrane 
of the intestine. Fat may occur in the stools, and be due to 
disease of the pancreas. Blood occurs from hemorrhage in 
the intestine. Pus may occur from the rupture of an abscess 
situated anywhere in the intestinal tract. Gall-stones and 
enteroliths are also diagnostic. Shreds of tissue and fibrinous 
casts from necrosis occasionally occur. They may be due to 
carcinoma of the bowel. Fibrinous casts occur particularly 
in the course of dysentery. Various forms of animal para- 
sites may also be found in the stools. 

Give the symptomatology of epilepsy. 

As a rule the attack comes on suddenly, the patient falling 



PRACTICE OF MEDICINE. 677 

to the ground unconscious. This may or may not be preceded 
by an aura. At first there are tonic spasms, the patient often 
biting his tongue and bloody foam appearing at the mouth. 
This is followed by clonic spasm, and this in turn is succeeded 
by epileptic coma. During the attack the pupils are markedly 
dilated. After the attack the patient usually falls into a 
deep, profound sleep lasting for several hours. 

Make a diagnosis of infantile spinal paralysis. 

The disease begins suddenly, often with convulsions, de- 
lirium and fever. The temperature rises suddenly, usually to 
about 103° F., there is pain in the back and limbs, and some- 
times diarrhea. Paralysis, as a rule, occurs suddenly. The 
paralysis is more extensive early and the muscles of the par- 
alyzed limb soon undergo atrophy. Reactions of degenera- 
tion are marked. The legs are most often attacked. Later, 
as a rule, marked improvement takes place. 

How may pleuritic friction sounds be distinguished from 
rales occurring in the bronchial tubes? 

A friction sound is close to the ear ; it is distinctly localized, 
and accompanied by pain on respiration. It may occur in 
inspiration or in expiration or be heard in both. As a rule 
there is no pain with rales ; they are further from the ear and 
are more diffused over the chest. 

What complication should be guarded against in inflam= 
matory conditions of the ear? 

The most important complication relates to an affection of 
the meninges. This is more apt to result from disease of the 
middle ear. 

Define cyanosis and give its causes. 

This is a blue-red condition of the skin, showing itself most 
prominently upon those parts that are normally bright red, 
such as the lips, cheeks, mucous membranes and the finger 
nails. Canosis is due to the accumulation of carbonic acid 
in the blood and a deficient amount of oxygen, the blood hav- 
ing a venous or hypervenous character. 



678 PRACTICE OF MEDICINE. 

What aids to diagnosis are utilized in the treatment of 
persons affected with stomach lesions? 

Inflation of the stomach may be practiced so as to determine 
the size and position of the stomach. The X-ray may be used. 
A test meal may be given, and the contents of the stomach 
withdrawn after a certain time. The contents are then tested 
for free HC1, pepsin, lactic acid, etc. 

State possible causes of dropsical conditions of the 
abdomen and lower extremities. 

This is 'most often due to disease of the heart, kidneys and 
liver. It occasionally occurs from profound anemia, and may 
be due to pressure in the abdomen, as from malignant disease 
or aneurysm. 

What causes general anemia? Make a diagnosis of 
general anemia. 

By the term anemia is meant a deficiency of the blood ? 
either in its bulk or in certain of its constituents. It is usually 
divided into primary and secondary anemia. By the term 
prmary — also called essential, idiopathic or cryptogenetic — 
anemia is meant a disturbance of the blood or blood-making 
organs, so that the anemia seems the distinctive feature of the 
disease, while other symptoms appear mainly dependent upon 
this change. Secondary anemia is due to some disease acting 
upon the blood or blood-making organs, the anemia not being 
the prime feature, but a symptomatic manifestation. The 
diagnosis depends upon a change in the blood itself, either in 
a diminution in the hemoglobin or in the number of blood 
corpuscles, or a change in both these constituents. There are 
also constitutional symptoms, such as pallor, shortness of 
breath, especially upon exertion, digestive disturbances and 
nervous symptoms. 

Mention and differentiate the species of tenia. 

In man three species of tapeworm which are fully developed 
commonly occur. The tenia echinococcus occurs only in its. 



PRACTICE OF MEDICINE. 679 

larval form. The three varieties are tenia solium, tenia 
saginata and the bothrioeephalus latus or tenia latus. The 
tenia solium is sometimes called the armed tapeworm, as the 
rostellum is supplied with two rows of hooklets, each row 
containing from twelve to fourteen hooklets. The head is 
quadrilateral, being supplied with four suctorial discs. The 
worm is about four meters long. The segments are from 6-8 
mm. in breadth and from 10-12 mm. length. In the tenia 
saginata the head is surrounded by four suckers, with a rudi- 
mentary sucker in the middle. The segments measure from 
8-10 mm. in width and are about 18 mm. in length. In the 
tenia lata the worm varies from 5-16 meters in length. The 
head is elongated, and supplied with two grooved suckers, one 
on each side. The breadth (1.8 cm.) of the joints is greater 
than the length. The mature segments show a rosette ar- 
rangement of the uterus which is characteristic. 

Describe the Brand method of treatment in typhoid 
fever. 

When the temperature in the axilla reaches 102.6° F. a cold 
bath is given, and repeated every three hours, the water being 
at a temperature of about 70° F. The patient should be 
immersed in the tub, the water covering all but the head ; then 
water of a lower temperature should be poured upon the 
patient's head or a wet ice pack used. Gentle friction should 
be applied constantly by the attendants, and the patient 
should be encouraged to do likewise. The abdomen should 
not be rubbed. The duration of the bath is 15 minutes. 
Some alcoholic stimulant should be administered to the pa- 
tient before and after the bath. When the bath is finished 
the patient should be lifted back to his bed and covered with 
woolen blankets. The temperature should be taken one-half 
hour afterward to note the fall produced by the bath. 

Give the symptoms and treatment of myocarditis. 

The symptoms may be entirely latent, and the condition in 
mild grades is not likely to be recognized. In the advanced 



680 PRACTICE OF MEDICINE. 

stages pain in the precordium, especially upon slight exertion, 
becomes prominent. It radiates and shoots down the left 
arm, and tingling may occur in the fingers. Shortness of 
breath is a prominent symptom. The apex beat is weak and 
diffused, the pulse is feeble, and often intermittent. Marked 
arrhythmia occurs. Constipation and gastric disturbances 
are common. In advanced stages edema of the skin may 
occur. The treatment consists in careful regulation of the 
diet, attention to the functions of the body, and the systemic 
use of such drugs as alcohol, strychnia, iodide of potassium 
and arsenic. 

What is the practical import of hematuria, and how can 
its source be diagnosed? 

Blood in the urine may be from the kidneys, in cancer 
acute nephritis, after powerful diuretics, etc. ; from the blad- 
der, in diphtheritic and acute cystitis, calculi, cancer, conges- 
tion, etc. ; from the prostate and as a result of mechanical in- 
jury. When blood is derived from the bladder the first that 
is passed will contain a smaller amount of blood than the last. 
Blood from the bladder may be copious in amount, and this 
urine in contrast to that containing blood from the kidney, 
upon standing, will show fibrin. Blood from the kidney is 
more likely to be intimately mixed with the urine, and if 
coagula be present they are apt to be washed out. From the 
urethra only the last drops are likely to be bloody. 

Give the etiology of scarlet fever. 

Age is an important predisposing cause. It rarely occurs 
after the tenth year of life. Neither sex nor occupation pre- 
dispose to it. The disease is more common in cold and tem- 
perate regions. Epidemics are more prevalent in the winter. 
In this disease there is a marked personal predisposition. 
One attack confers immunity as a rule. The exciting cause 
is not known. 

Give the treatment of tic douloureux. 

It is especially important to treat the underlying condition. 



PRACTICE OF MEDICINE. 681 

If the disease be reflex it is important to give attention to the 
affection giving rise to it. Hygienic treatment is of import- 
ance. Change of scene and residence, with good, nourishing 
diet, are necessary. Many drugs have been recommended for 
the treatment of the paroxysm, such as quinine, the coal-tar 
analygesics, the salicylates, caffeine, aconite, gelsemium and 
belladonna. Morphine should be avoided if possible, as there 
is great danger of the patient acquiring the opium habit. 
Local treatment is sometimes of use, thus hot and cold appli- 
cations, liniments containing menthol, and occasionally elec- 
tricity may be tried. In protracted cases surgical interfer- 
ence should be thought of. 

Give the symptoms of appendicitis. 

The onset is sudden ; there is pain in the abdomen, which at 
first may be general or centered around the umbilicus, and 
occasionally in the epigastrium and in the left or right iliac 
fossa. In many cases the pain is confined to the right iliac 
fossa, and directly in the region of the appendix (McBurney's 
point) . If the pain is general it soon localizes itself to the 
right iliac fossa, usually within the course of twenty-four 
hours. It is paroxysmal or intermittent, and colic-like. This 
pain may be preceded by chilliness. Frequently nausea and 
vomiting mark the beginning of the attack. Fever rapidly 
follows the onset of the disease, and is usually moderate, 
from 100°-103° F. Occasionally it may be absent. The fre- 
quency of the pulse generally corresponds to the degree of 
the fever. Constipation is commonly present, The tongue 
is coated posteriorly. The facial expression of the patient 
shows anxiety and suffering. The position of the patient is 
often characteristic. The right thigh is frequently partially 
flexed upon the abdomen, while the left leg is extended. 
Examination of the abdomen shows slight distension. On 
palpating the abdomen the right rectus muscle will be found 
rigid. Tenderness is as constant as pain. Pressure upon 
the opposite side produces pain in the region of the appendix. 



682 PRACTICE OF MEDICINE. 

In some instances the appendix may be clearly made out, and 
occasionally a tumor is palpable. 

Define aphasia and give its etiology. 

Aphasia embraces a variety of defects in the use or the 
comprehension of language, either spoken or written. In the 
majority of cases aphasia is one of the symptoms of organic 
local cerebral disease, occurring in the left hemisphere in the 
right-handed, and vice versa. It occurs in cerebral hemor- 
rhage, thrombosis, embolism, abscess, tumor, and depressed 
fracture of the skull. Rarely it has been noted in hysteria 
and neurasthenia. 

Give the diagnosis and treatment of acute follicular 
tonsillitis. 

The diagnosis depends upon great pain in swallowing. This 
may be preceded by lassitude, malaise, headache, pain in the 
bones, vomiting, and marked fever. Examination of the 
throat shows redness and swelling of one or both tonsils, with 
yellowish-white patches upon them, varying in size from a 
pin-head to a split pea. These may be stripped off without 
leaving a bleeding surface, leaving an intact mucous mem- 
brane beneath. The breath is usually fetid. The patient 
should be put to bed and a laxative administered. The coal- 
tar products, especially phenacetine, in small doses, guardedlv 
given, promptly relieve the pain. Ice bandages and small 
particles of ice in the mouth are useful. If pain and sleep- 
lessness persists, opium, especially Dover's powder, may be 
administered. 

Give the treatment of intestinal hemorrhage in typhoid 
fever. 

Food and drink should be withdrawn ; one or more ice-bags 
applied to the right iliac fossa, and opium given for effect. 
The head of the bed may be lowered and the foot of the bed 
elevated. The opium should be pushed so as to produce 
mild somnolence. If thirst becomes excessive, small pellets 
of ice may be placed in the mouth from time to time. 



PRACTICE OF MEDICINE. 683 

Give the treatment of delirium tremens. 

One of the most important features in the treatment is care- 
ful feeding. Little food should be given at a time, but it 
should be frequently administered. If vomiting is persistent, 
rectal alimentation may be resorted to. If there are signs of 
heart failure stimulants must be administered. Strychnine 
hypodermically is of great value. Every effort should be 
made to induce sleep. The most useful agents are morphine 
hypodermically, or hyoscine. Chloral is also useful, but it has 
a depressing effect upon the heart. 

Give the treatment and prognosis of progressive pernio 
cious anemia. 

Rest in bed is essential, and easily digested, nutritious foods 
should be given. Arsenic has been found of most value, given 
in the form of Fowler's solution in ascending doses. If this 
drug is not well borne iron may be substituted. Bone marrow 
is also useful. Stimulants, such as strychnine and alcohol, 
and inhalations of oxygen, are of advantage. The prognosis 
is always grave. Death results in from a few months to a few 
years. Apparent recovery followed by relapse is common. 

Give the symptoms of acute exudative nephritis. 

The disease may begin suddenly or gradually. Edema 
develops rapidly. The urine becomes scanty and high col- 
ored, and uremic symptoms, such as vomiting and convulsions, 
occur. The edema at first is most marked in the face, partic- 
ularly about the eyelids. There is dull headache, with pain 
in the back and loins, dryness of the skin and dyspnea. The 
temperature is sub-febrile. The urine upon examination 
shows that it is decreased in amount, the color is dark red and 
is turbid, blood being present. The specific gravity is from 
1020 to 1030, and upon testing the urine large quantities of 
serum albumin are found. The quantity of urea is usually 
less than normal. Under the microscope hyaline, granular 
and epithelial casts are noted, with renal epithelium, red blood 
cells and granular matter. 



684 PRACTICE OF MEDICINE. 

Define and describe bronchorrhea. 

This is a rare form of bronchitis, characterized by an exces- 
sive amount of secretion, which is very foul. It is sometimes 
called purulent bronchorrhea. The quantity of expectoration 
varies from one to three pints. The character may be either 
thin or watery or it may be transparent or ropy. Dyspnea 
and cough are always present, often being persistent and 
paroxysmal. 

Define hydronephrosis. State its causes and describe 
its treatment. 

Obstruction to some part of the ureter, bladder or urethra 
may give rise to dilatation of the pelvis and tubules of the 
kidney from accumulation of urine. It may be due to the 
twisting of the ureter, it may result from congenital narrow- 
ing of the ureter or urethra, from pressure. The treatment 
is largely surgical. Massage may be practiced with favorable 
results. However, if the condition persists, aspiration and 
drainage are necessary. 

Give the symptoms and treatment of migraine. 

The principal symptom is the headache, which shows greater 
or less periodicity. This symptom is followed by pallor and 
some vasomotor spasm. As a rule the disease is unilateral, 
the left side being oftener affected than the right. The pupil 
upon the affected side is often smaller, and the eye may be 
retracted. Often there is disturbance of vision, the duration, 
however, being temporary. Occasionally, tinnitus aurium 
occurs, which may be associated with vertigo. These symp- 
toms are accompanied in the majority of cases by marked 
gastric disturbances, such as nausea, with frequent vomiting. 
The treatment consists in relieving the pain and the preven- 
tion of its recurrence. The following drugs have been recom- 
mended: Ergot, the coal-tar products, salicylate of sodium, 
the bromides, caffeine and gelsemium. As a prophylactic, 
nitroglycerin taken after meals with bismuth and pepsin has 
been said to be of value. Mild purging with calomel from 
time to time often prevents attacks. 



PRACTICE OF MEDICINE. 685 

Mention a disease of the nervous system in which the 
patella reflex usually disappears; one in which it is usually 
exaggerated. 

In locomotor ataxia the knee-jerk usually disappears; in 
spastic paraplegia, as a rule, the knee-jerk is exaggerated. 

Define myxedema and give its treatment. 

This is a disease characterized by a myxomatous change in 
the subcutaneous tissues due to pathologic lesions in the thy- 
roid gland causing diminished or absent secretion. Thyroid 
extract should be administered as early as possible, and should 
be continued until all the symptoms disappear, and then a 
prophylactic dose must be given regularly. General tonics, 
such as iron, quinine and strychnia, are of value. 

Define simple acute stomatitis; at what age is it most 
common and what is its treatment? 

This is an inflammation of the mucous membrane of the 
mouth. The disease is most frequent in children, but may 
also occur in adults. The treatment consists in cleanliness, 
careful feeding, and the use of a mild alkaline mouth wash. 
A mild purge is often advantageous. 

Give the causes and treatment of bronchial asthma. 

The disease is sometimes hereditary. It is more common 
in males than in females. It may follow an attack of bron- 
chitis, and is commonly associated with chronic bronchitis 
and emphysema. The inhalation of dust, the pollen lof 
certain plants, fog, fumes, vapors, odors that emanate from 
certain animals may produce an attack of asthma. Reflex 
causes, as irritation from nasal polypi, causes relating to the 
gastro-intestinal tract, skin or genito-urinary center may act 
in a like manner. For the treatment of the paroxysm nar- 
cotics and anti-spasmodics are usually employed. Chloral, 
whiffs of chloroform or ether, amyl nitrite by inhalation, or 
morphia and atropia hypodermically are useful drugs. Re- 
lief sometimes follows the inhalation of nitre-paper cigarettes, 



686 PRACTICE OF MEDICINE. 

which also contain lobelia and stramonium. Sinapisms and 
turpentine stupes to the chest may be of value. 

Give the treatment of an acute attack of gout. 

A mild laxative at the onset is useful. The affected joint 
should be kept at rest, and a diet of milk and farinaceous 
articles, with plenty of water, should be insisted upon. If 
the pain become severe opium in some form must be adminis- 
tered. For the attack itself colchicum is the remedy. Iodide 
and bromide of potassium are also useful, as are also the 
salicylates and the salts of lithia. 

State the prognosis in aneurysm of the thoracic aorta. 

The prognosis is always grave, death invariably resulting. 

Differentiate broncho=pneumonia and incipient phthisis. 

This is very frequently difficult, incipient phthisis often 
occurring as a localized broncho-pneumonia, Broncho-pneu- 
monia follows an acute bronchitis, making itself known by a 
rise in temperature over 103° F., by an increase in the respi- 
ratory and pulse rate, the pulse commonly running from 120- 
160 per minute, while the respiratory rate may be from 40-80 
per minute. Broncho-pneumonia occurs at the extremes of 
age. The physical signs of well-developed broncho-pneumonia 
are, upon inspection, an increased respiratory rate ; on palpa- 
tion, increased vocal fremitus in areas over both lungs; upon 
percussion, localized areas of dulness over both lungs (more 
marked posteriorly) surrounded by a tympanitic area; on 
auscultation, broncho-vesicular breathing subcrepitant rales 
mixed with large and small mucous rales. The physical signs 
are all more marked posteriorly, and are usually well marked 
•at the bases. 

Incipient phthisis has a gradual onset with loss of appetite, 
gastric disturbance, slight evening rise of temperature (100° 
or thereabouts), anemia and general malaise. There is, as a 
rule, slight cough with scanty expectoration (the tubercle 
bacillus may be found in the expectorated material). Occa- 



PRACTICE OF MEDICINE. 687 

sionally there is slight hemotysis or the sputum may be blood- 
tinged ; there is a progressive loss of weight. The physical 
signs relate principally to the apices. There is a slight im- 
pairment of resonance at one or both apices on percussion, 
and upon auscultation there may be heard slight friction 
sounds, harsh breathing and some fine moist rales. 

What are the diagnostic signs of retro=pharyngeal 
abscess? 

This may follow the infectious fevers, such as scarlet fever 
or diphtheria, usually in young children, ocasionally due to 
caries of bone. There is pain on swallowing (dysphagia), 
difficulty in breathing, occasionally hoarseness, cough and 
stiffness of the neck. Upon examination of the throat by 
inspection and palpation there is discovered a fluctuating 
tumor which projects from the posterior wall of the pharynx. 

Differentiate tonic and clonic spasms. 

A tonic spasm is a continuous spasm; a clonic spasm is an 
interrupted one with contraction and relaxation. 

Describe the symptoms of a case of apoplexy due to 
cerebral hemorrhage. 

Prodromes may precede the attack, such as nausea, vomit- 
ing, vertigo. As a rule, the attack comes on suddenly, the 
patient becoming comatose. The face is flushed or pale. There 
is stertorous breathing, occasionally of the Cheyne-Stokes 
type. There is conjugate deviation of the head and eyes ; the 
pupils are irregular, and there is evidence of hemiplegia. 

Differentiate acute bronchitis from lobar pneumonia, 

In acute bronchitis there is cough, at first without, later 
with mucopurulent expectoration; subfebrile temperature, 
and slight pain under the sternum. There are no changes 
from the normal on percussion, but upon auscultation there 
are at first dry rales, followed by moist rales. Lobar pneu- 
monia is characterized by sudden onset, with marked chill, high 
temperature, "stitches in the side," cough, a sputum which 



688 PRACTICE OF MEDICINE. 

is very tenacious and often rusty; full pulse at first, later 
becoming rapid. The physical signs are quite characteristic. 
There is, in the first stage, the crepitant rale, in the second 
stage dulness on percussion with bronchial breathing and, in 
the last stage, "crepitus redux." 

Differentiate hemoptysis and hematemesis. 

Hemoptysis. Hematemesis. 

Blood is bright red and frothy ; often Blood is dark, clotted and often 

coughed up. mixed with food ; is vomited. Stools 

may be tarry. 

Alkaline in reaction. Acid in reaction. 

Containing air bubbles. Air bubbles absent. 

Tubercle bacilli may be present in the No tubercle bacilli in the blood, 
blood. 

Differentiate rheumatism from gout. 

Gout occurs suddenly and shows a special preference for 
the smaller joints, especially the great toe. Rheumatism 
comes on more gradually and attacks principally the large 
joints. The appearance of the joint in gout is swollen, glossy, 
tense and bluish. There is less sweating and less fever than 
in rheumatism; gastric and nervous symptoms are never 
prominent. Implication of the membranes of the heart in 
gout is decidedly less frequent than in rheumatism. 

Differentiate intestinal colic, uterine colic and renal 
colic. 

Intestinal Colic. — Diffuse pain, which may be localized, 
very severe in character ; usually of sudden onset, relieved by 
pressure ; lasting, as a rule, a few hours. A free discharge of 
flatus relieves the attack. 

Uterine Colic. — The pain is in the pelvis, there is some his,- 
tory of uterine discharge and disease. 

Renal Colic. — The pain starts from the region of the kidney, 
shooting down the ureter. There is retraction of the testicle ;. 
often nausea and sometimes vomiting. 



PRACTICE OF MEDICINE. 689 

Give the physical signs of the most usual valvular lesion 
of the heart. 

Mitral insufficiency is the most common valvular lesion of 
the heart. The physical sign is a murmur at the apex, systolic 
in time and transmitted to the left axilla and the angle of the 
scapula. 

Differentiate pleurisy and pneumonia. 

In pleurisy there is a friction sound heard commonly both 
in inspiration and expiration; fever is slight, there is marked 
pain in breathing. There may be slight cough. In the first 
stage of pneumonia there is a pleurisy, especially when the 
inflammatory exudate reaches the periphery of the lung. 
There is high fever, which is preceded by a marked chill, 
cough, rusty sputum and the physical signs (crepitant rale, 
dulness on percussion, bronchial breathing and crepitus 
redux). 

What conditions might cause alvine discharge contain= 
ing fat? 

In obstructive jaundice fatty stools are sometimes noted; 
they occur occasionally in overfed infants. Fatty stools are 
often indicative of disease of the pancreas, such as cancer or 
pancreatic calculi. 

Give the characteristic symptoms of purpura hemor= 
rhagica. 

Hemorrhages from the mucous membranes and extravasa- 
tion in the cutaneous surfaces ; great weakness, anemia due to 
loss of blood. Fever is present, as a rule. 

What conditions increase the amount of uric acid voided 
with the urine? 

Increased by diet (fat and sugar), muscular exercise. In 
the acute fevers (pneumonia and rheumatic fever), in leuke- 
mia and in disease of the spleen generally ; in diabetes and in 
lithemia. It is decreased in amount under strict milk diet, in 
44 



690 PRACTICE OF MEDICINE. 

anemia, chronic lead-poisoning and chronic interstitial neph- 
ritis. 

Differentiate thrombosis and embolism. 

Thrombosis. — Prodromes are common, drowsiness and head- 
ache, the onset of the attack is insidious. Hemiplegia gradual 
in onset. Ocular and other nerve palsies. 

Embolism. — Loss of consciousness rapid, hemiplegia and 
disturbances of the pulse and respiration. Embolism is more 
frequent in the left side of the brain, hence valvular disease 
favors embolism. 

What diseases are liable to occur in the right inguinal 
region? 

Appendicitis, floating kidney, disease of the liver and of the 
bladder. 

Distinguish between the terms illusion, delusion and 
hallucination as used in diagnosis. 

An illusion is a wrong conception of an object which really 
exists. A delusion is an absurd and unfounded belief. A 
hallucination is a sense perception without a physical basis. 

Give the physical and rational signs of pericarditis be= 
fore and after effusion. 

There is slight fever, marked pain in the precordial region, 
dyspnea and irregular, usually quickened, pulse. There is 
pericardial friction on auscultation. When effusion occurs 
the friction disappears ; there is dulness in the precordial area, 
the base of dulness being at the apex of the heart, quite the 
reverse from the usual condition. 

Define vocal fremitus and state its significance in pul= 
monary disease. 

Vocal fremitus means the vibrations of the voice which 
are transmitted to the chest wall. These are conducted from 
the larynx by the trachea and bronchi to the smaller tubes 
within the lungs, and thence through the lung tissue to the 



PRACTICE OF MEDICINE. 691 

surface. Yocal fremitus is increased by consolidated lung 
tissue ; it is increased from an empty pulmonary cavity super- 
ficially situated, and is diminished or lost on accumulation of 
fluid in the pleural cavity. 

Differentiate between sunstroke (coup de soleil) and 
apoplexy. 

In sunstroke there is the history of exposure to the sun. 
The temperature is very high, 105°-115° or over, but no evi- 
dence of hemiplegia. In apoplexy there is conjugate devia- 
tion of the head and eyes, hemiplegia, irregular pupils, never 
so high a temperature, and full, bounding pulse. 

What casts are frequently found in albuminous urine 
and what do they denote? 

Hyaline, granular, epithelial and blood casts. Hyaline 
casts probably result from the exudation or secretion of a 
material from the epithelial cells lining the tubules. They 
are sometimes found in healthy individuals. Granular casts 
indicate nephritis. Epithelial casts are always indicative of 
a renal lesion. Blood casts are found in acute parenchyma- 
tous nephritis or in a condition in which the renal tubules 
become filled with red blood corpuscles. 

Of what import is the spleen in the diagnosis of febrile 
conditions? Give the topography of the spleen. 

As a rule, the spleen is enlarged in all febrile conditions. 
The spleen extends from the ninth rib to the margin of the 
twelfth rib in the midaxillary line of the left side. 

Differentiate the crepitant rales and the subcrepitant 
rales and give the clinical significance of each. 

The crepitant rale is a fine moist rale and is heard only at 
the end of inspiration. It is found in the vesicular structure 
of the lung. The subcrepitant rale is also a fine moist rale, 
somewhat coarser than the crepitant rale, found in the finer 
bronchi and heard both in inspiration and in expiration. 
The crepitant rale is heard in croupous pneumonia, broncho- 



692 PRACTICE OF MEDICINE. 

pneumonia, hemorrhage, pulmonary infarcts, edema of the 
lung and sometimes in tuberculosis. The subcrepitant rale 
is heard in congestion and edema of the lungs, in hemorrhage 
or in any condition in which fluid is present in the finer bron- 
chi; in pulmonary tuberculosis, in the third stage of croupous 
pneumonia and in broncho-pneumonia. 

What are the manifestations of hereditary syphilis? 

The child at birth is very feeble, and the eruption may be 
present ; the child snuffles, the mouth is fissured, and the lips 
are ulcerated. Liver and spleen are enlarged, and bone symp- 
toms are prominent, If the symptoms do not appear at birth, 
they will appear at or about the third month. There is then 
nasal catarrh, with a seropurulent discharge. Necrosis of 
bone is rapid, and the nose undergoes a characteristic de- 
formity. Lesions of the skin also appear. When the teeth 
appear they are notched (Hutchinson's teeth). 

Make a diagnosis of aneurysm of the descending aorta. 

There is marked pain, especially in the back, and a large 
tumor may appear posteriorly in the scapular region. Para- 
plegia may occur from pressure on the cord, dysphagia from 
pressure on the esophagus, and pulmonary symptoms from 
pressure on the left bronchus. There are, besides, all the 
physical signs of aneurysm in any other locality, such as ex- 
pansible pulsation, tumor, bruit and thrill. 

Make a differential diagnosis of pleuritic and pericardial 
effusion. 

If the pericardial effusion be very great, it may much 
resemble a left-sided pleural effusion. In pericardial effusion, 
however, there is pulmonary resonance at the base, Skodaic 
resonance in the axilla, and the heart is not displaced to the 
right of the sternum. The dyspnea is greater in pericarditis 
with effusion, and the paradoxical pulse may be present. An 
antecedent history of rheumatic fever may help the diagnosis 
and favor pericarditis. 



PRACTICE OF MEDICINE. 693 

Describe the treatment of hay fever. 

A change of residence before the annual attack is the only 
prophylaxis ; a correction of the neurotic and gouty tendency 
of the individual should be attempted. A spray to keep the 
nasal passages clean is important. A weak solution of cocaine 
for this purpose is valuable. Suprarenal extract appears to 
give the best results both locally and internally. 

Define epidemic parotitis. What complications may 
arise in the course of this disease? 

There is abrupt development of fever and an enlarged par- 
otid gland on one side. Inflammatory edema of the surround- 
ing tissue is common, the ear may be pushed upward. The 
mouth is displaced and the face disfigured. The fever is 
usually about 102°. In some cases the opposite gland becomes 
affected after a few days. * Suppuration does not occur. 
Occasionally other glands, such as the testicles, ovaries and 
mammary glands, are affected. 

Define chlorosis. 

Chlorosis is a form of primary anemia, affecting chiefly 
females at the time of puberty, and characterized by marked 
-diminution of the hemoglobin. 



INDEX 



Abdomen, regions of, 39 
Abdominal aorta, 32, 71 

muscles, 10 

viscera, 27 
Abortion, 456, 457, 458, 459 
Abscess, 326, 370, 387, 389 
Absorption, 104 
Accomodation, 82, 108 
Acetabulum, 14 
Acetanilide, 548, 575 
Acetic acid, 184, 208, 590 
Acetone, test for, 303 
Acetous fermentation, 196 
Acids, definition of, 203 
corrosion by, 181 
antidote for, 248 
Aconite, 522, 549, 562, 565 
Aconitine, dose of, 546 
Acromegaly, 366 
Adenoma, 387 
Adipose tissue, 317 
After pains, 474 
Agglutinins, 326 
Air, analysis of, 260 
Albuminoids, 185 

Albumin, test for, 188, 192, 233, 246 
Albuminuria of pregnancy, 454 
Albumose, 303 
Alcohol, 183, 269, 545, 608 

drinking of, 90, 141, 142, 

166, 330, 416, 541, 651, 

672 
methyl, 288 

percentage in wines, 183 
Alcoholic fermentation, 235 

liquors, 201, 210, 231, 239 
Aldehydes, 300 
Alimentary canal, 50 
Alkali, 204 

group, 268 
Alkaloids, 182, 271, 290 
Allantois, 438 
Allotropism, 217 
Alloy, 224 
Aloes, 554 



Altitude, effect of, 169 

Alum, 251, 261, 554 

Aluminum, 207, 228 

Amalgam, 224 

Amenorrhea, 512 

Amid, 179 

Amins, 254 

Amnion, 438 

Amorphous, definitions of, 175, 265 

Ammonia, 204, 281, 286, 299, 549 

Ammonium, 279 

Ammonium compounds, 



178, 
262, 
554, 



231, 
549, 
572 



source of, 178 

Amphiarthrosis, 19 

Amputations, 364, 390, 425 

Amyl nitrite, 528, 540 

Amyloid degeneration, 308, 325, 335 

Anatomy, 9 

Anemia,' 308, 311, 315, 335, 512, 
520, 678 
pernicious, 315, 669, 683 

Anesthetics, 197, 221, 385, 535, 609, 
610, 611, 612 

Aneurysm, 321, 352, 366, 388 

Angina pectoris, 616, 633 

Angioleucitis, 336 

Angiomata, 319, 386 

Anhydride, 211 

Anilid, 179 

Anilin, 299 

Ankle joint, 16, 38, 41, 389 

Ankylosis of jaw, 340 

of joints, 344 
varieties of, 402 

Anodynes, 521 

Anospinal center, 112 

Antagonist, 552 

Anthelmintics, 581 

Anthrax, 618 

Antidotes, 254, 552 

Antimony, 265, 302 

Antipyretics, 564 

Antipyrine, 559, 592 

(695) 



696 



INDEX. 



Antiseptics, 566 
Antitoxin, 145, 571 
Antrum maxillae, 430 
Aortic aneurysm, 623, 686, 692 
insufficiency, 86, 645, 669 
stenosis, 645 
valve, 102 
Aphasia, 125, 682 
Aphonia, 125 
Apnoea, 92 

Apomorphine, 540, 594 
Aponeurosis, 14 
Apoplexy, 416, 533, 634, 651, 687, 

691 
Appendicitis^ 36, 362, 650, 663, 681 
Appendix vermiformis, 22, 46 
Arnica, 605 
Arsenic, 177, 194, 197, 217, 243, 283, 

302, 532, 586 
Arterial pulse, 643 
Arteries, aorta, 32, 48 

axillary, 20 

basilar, 44 

brachial, 18, 29 

carotid, 11, 45 

celiac axis, 65 

degeneration of, 323, 324, 
335 

femoral, 23, 27 

intercostal, 29 

internal carotid, 40 

internal iliac, 67 

ligation of, 348, 356, 382, 
384, 385, 390, 391, 392, 
399, 402 

meningeal, 38, 354 

of bladder, 41 

of forearm, 41 

of hand, 52 

of heart, 30 

palmar arch, 36 

popliteal, 65 

post-tibial, 60 

pulmonary, 70 

structure of, 105 

subclavian, 26 

ulnar, 68 
Arthritis deformans, 327 
Arytenoid cartilages, 67 
Asafetida, 540 
Ascites, 321, 420, 654 
Asphyxia, 74, 121 
Asthma, 532, 685 
Astigmatism, 131 
Atavism, 91 



Atheroma, 320 

Atmosphere, composition of, 198 
Atom, definition of, 189 
Atomic theory, 216 

weight, 174, 199, 211 
Attraction, forces of, 192 
Atrophy, 318, 401 
Atropine, 261, 527, 538, 603 
Auditory apparatus, 17 

vertigo, 117 
Aural labrynth, 65 
Axilla, 32 

Bacteria, 308, 335, 336 

Baking powder, 282, 294 

Ballottement, 446 

Balsam of Peru, 529 

Barley water, 564 

Barometer, 264 

Base, definition of, 209 

Basic radical, 209 

Bassini's operation, 369 

Bathing, 155 

Baths, 137, 153, 169 

Belladonna, 528, 531, 542, 554, 558, 

568, 579 
Benzene, 270 
Benzoin, 591 
Bile, 108, 109, 134, 207 

duct, occlusion of, 337 
test for, 246 
Biliary calculi, 238, 614, 617, 625, 

632, 648 
Bilirubin, 303 
Binary compounds, 203 
Bismuth, 263, 298, 572, 585 
Bladder, 27, 28, 58, 425 

injections for, 596 
Blisters, 524 
Blood, circulation of, 93 

coagulation of, 74, 97 

composition of, 104 

corpuscles, 105, 110, 114, 
116, 124 

description of, 128 

expectoration of, 675 

function of, 78, 104 

plasma, 333 

pressure, 93, 98 

quantity of, 76 

reaction of, 133 

stains, 120 

tests for, 246, 302 

vessels, 81 
Blow-pipe, 201, 271 



INDEX. 



697 



Blue pill, 591 
Blushing, 92 

Body, composition of, 94 
Bones, clavicle, 28 

frontal, 36 

humerus, 12 

inflammation of, 324 

malar, 41 

occipital, 16 

of foot, 16 

of hand, 44 

of head, 14 

of heel, 30 

of pelvis, 31 

ossa innominata, 57 

parietal, 78 

patella, 31 

radius, 32 

sternum, 58 

superior maxilla, 59 
Borax, 527, 604 
Boric acid, 527 
Boroglycericl, 230 
Boron, 255 
Brachial plexus, 9 
Brain, anemia of, 320 

convolutions of, 52 

corpus callosum, 71 

cortex cerebri, 80 

fissure of Eolando, 69 

Sylvius, 29, 69 

fourth ventricle, 41 

function of, 73 

gray matter of, 134 

lobes of, 23, 45 

medulla oblongata, 63, 89 

membranes of, 25, 120 

motor area of, 118 

pia mater, 44 

pons varolii, 26 

tumor, 422 

ventricles of, 41, 43 
Brand treatment, 679 
Breasts, removal of, 343 
Bright 's disease, see Nephritis 
Bromides, 519, 540, 589 
Bromine, 216 
Bromism, 543 
Bryonia, 546 
Bubonic plague, 139, 333 
Buchu, 557, 559 
Buckthorn, 589 
Bunions, 364 
Bunsen burner, 202 
Burns, 342, 389 



Bursitis, 364 
Butter, 137, 186 
Butyric acid, 298 

Caffeine, 535, 565 

Calabar bean, 531, 542 

Calcific metamorphosis, 334 % 

Calcium chloride, 544 

Calculi, biliary, 238, 614, 617, 625, 
632, 648 
urinary, 187, 304 

Calculus formation, 225 

Calomel, 216 

Camphor, 530, 538, 591, 603 

Camp hospital, 150 

Cannabis Indiea, 543, 574 

Cantharides, 527, 560, 595 

Capillaries, 83 

Capillary attraction, 254, 290 

Capsicum, 548, 587 

Caput succedanum, 463 

Carbohydrates, 220, 223, 241, 264 

Carbolic acid, 184, 291, 523, 548, 

552, 608 
| Carbo ligni, 534, 588 
1 Carbon, 259 

oxides of, 220, 273, 280 

Carbuncle, 387 

Carcinoma, 310, 313, 314, 367, 427, 
428 

Cardamon, 537 

Cardio-inhibitory centers, 127 

Caries, 317 

Cartilage, 87, 124 

Cascara sagrada, 548, 565 

Castration, 396 

Casts in urine, 691 

Cataphoresis, 610 

Cathartics, 532, 588 

Cecum, 39 

Celiac axis, 65 

Cell growth, 121 

Cells of body, 114, 124 ' 

Cemeteries, 155 

Cerebellum, 73 

I Cerebral hemorrhage, 307, 332 
softening, 316 
tumor, 674 
veins, 61 

Cerebro-spinal fever, 314, 661 

Cerebrum, removal of, 76 

Cerumen, impacted, 408 

Cervical caries, 397 

vertebrae, 14 

Cervix uteri, 70, 492 



698 



INDEX. 



Cesarian section, 506 
Chancre, 430 
Chancroid, 426, 430 
Chemical action, 196, 213 

affinity, 173 
Chemistry, 240 
Chest ki respiration, 116 
Cheyne-Stokes respiration, 673 
Chicken-pox, see Varicella 
Chloral, 229, 238, 521, 580, 587 
Chlorides, 196 
Chlorinated lime, 219 
Chlorine, 178, 206, 224, 248 
Chloroform, 183, 229, 248, 256, 274, 

569, 579, 609, 611 
Chlorosis, 512, 663, 693 
Cholagogue, 539 
Cholera, Asiatic, 160, 626, 652, 669 

morbus, 620, 652 
Cholesterin, 114 
Chorda tympani, 75 
Chorea, 614, 668 
Chyle, 74, 103 
Chyme, 74 
Chromic acid, 551. 
Chromium, 301 
Cicatricial changes, 323 
Ciliary processes, 72 
Cinchona, 522, 574, 584 
Cinnamon, 579 
Circumcision, 406 
Cirrhosis of liver, 310, 314 
Citric acid, 293 
Clavicle, 28 
Climate, 146, 153 
Clubfoot, 403 
Coal gas, 600 
oil, 289 
Cocaine, 524, 550, 605 
Codeine, 559 
Coffee, 165 

Colchicum, 527, 539, 548, 601 
Colic, 688 
Collodion, 181, 581 
Colloid degeneration, 311 
Collyrium, 566 
Colocynth, .539, 608 
Color blindness, 120 
sensation, 95 
Colostomy, 365 
Columnae carneae, 133 
Coma, 416 
Combustion, 201 
Comma bacillus, 309 
Complimental air, 126 



Compounds, 240 
Congestion, 350, 363 
Conium, 531, 541 
Connective tissue, 9, 113 
Constipation, 144 
Convallaria majalis, 535 
Cooking, effect of, 157 
Copaiba, 609 
Copper, 177 

sulphate, 242, 519, 539, 604 
Corpus luteum, 119 
Corrosive sublimate, see Mercuric 

chloride 
Coryza, 657 
Cough, prescriptions for, 531, 547,. 

600 
Craniotomy, 505 
Cream of tartar, 262 
Cremation, 167 
Creosote, 559, 582 
Cretinism, 315 
Croton oil, 519, 551 
Croup, 604, 613 
Crystalline, definition of, 175 

lens, 24 
Crystals, formation of, 197» 
Cubebs, 551 
Curare, 559 
Cyanogen, 227 
Cyanosis, 677 
Cystocele, 571 
Cysts, 308 

Death-rate, average, 138 

Death, changes in body after, 209 

Decay, 266 

Defecation, 112 

Degeneration, 311 

Deglutition, 74 

Delirium tremens, 661, 683 

Dermoid cysts, 418 

Destructive distillation, 195 

Diabetes insipidus, 624 

mellitus, 619, 624, 643, 
656, 663 
Diacetic acid, 303 
Dialysis, 244 

Diaphoretics, 532, 541, 598 
Diaphragm, 23, 77, 110 
Diarrhea, 568 
Diarthrosis, 19 

Diet, 73, 98, 121, 133, 144, 163, 237 
Digestion, 77, 82, 96, 101, 104, 106, 

126 
Digestive secretions, 79, 84, 86 



INDEX. 



69$ 



Digitalis, 523, 553, 561, 565, 570, | 

592, 594 
Diphtheria, 143, 150, 158, 165, 309, ! 

315, 627, 630, 649, 669 
Disinfectants, 155, 157, 159, 215 
Dislocations, 389, 396, 427, 429 

elbow, 374 

forearm, 431 

head of femur, 373 

hip, 391, 415 

inferior maxilla, 394 

knee, 419 

shoulder, 350, 376, 394, 
413 
Diuretics, 525, 532, 584 
Donovan's solution, 538 
Dosage for children, 595 
Dover 's powders, 555 
Dropsy, 670, 678 
Ductus communis choledochus, 9 
Duodenum, absorption from, 93 
Dura mater, 37 
Dysentery, 650 
Dysphagia, 92, 366, 623 
Dyspnoea, 92 
Dystocia, 480 

Ear, diseases of, 385, 396 
Eclampsia, 493, 494 
Ectopic pregnancy, 459, 460 
Eczema, 315, 333 
Edema, 308 
Effervescence, 234 
Efflorescence, 234 
Elastic tissue, 112 
Elaterin, 582 
Elbow, 27, 47 

resection of, 422 
Electric battery, 285 

light, '256 
Electricity, 271 

Element, 'definition of, 206, 240 
Embolism, 320, 690 
Embryotomy, 505, 506 
Embryo, human, 443 
Emetics, 532, 569 
Emmenagogue, 531 
Emulsification, 109, 561 
Emulsion, 270 
Encephalon, 88 
Endemic diseases, 135 
Endocarditis, 624, 635, 637, 650 
Endocardium, 26 

Endometrium, diseases of, 456, 510 
Endosmosis, 229 



Endothelium, 11 

Enteric fever, see Typhoid 

Enteritis, 319, 644, 650 

Enzymes, 223 

Epidemic diseases, 135 

Epiglottis, 88 

Epilepsy, 618, 648, 676 

Episiotomy, 470 

Epistaxis, 413 

Epithelioma, 308 

Epithelium, 65, 73, 122 

Epsom salts, 598 

Equations, chemical, 196, 199, 204 r 
210, 213, 217, 218, 223, 226, 227, 
229, 242, 244, 250, 251,, 256, 258, 
263, 266, 267, 269, 274, 279, 285, 
286, 287, 289, 296, 297, 298, 300. 
302 

Erectile tissue, 106 

Ergot, 530, 560, 597 

Eruptive fevers, 639, 658 

Erysipelas, 410, 616, 655 

Erythroxylon, 572 

Escharotics, 567 

E serine, 580 

Esophageal stricture, 386, 620 

Esophagus, 42, 46 

Ether, 245, 270, 521, 610, 612 

Ethers, compound, 208 

Eucalyptus, 596 

Eustachian tube, 23, 119 

Eutocia, 483 

Evaporation, 198 

Exanthemata, 675 

Excipient, 563 

Excreta, disposal of, 162 

Exophthalmic goitre, 636 

Exophthalmos, 396 

Eye, 40, 42, 59, 65, 66 

enucleation of, 403, 412 
movements of, 110 
pupil of, 89 
refractory media of, 99 

Factory hygiene, 139 
Fallopian tubes, 36 
Faradic current, 258 
Fats, 80, 186, 287 
Fatty degeneration, 318 

infiltration, 318 

metamorphosis, 312 
Favus, 335 
Feces, 89, 147, 676 
Fecundation, 437 
Fehling's test, 249, 262, 304 



700 



INDEX 



Female reproductive organs, 433 
Femoral hernia, 46 
Fermentation, 277 
Fetal heart sounds, 446 
Fetus, 444, 445, 474 
Fibrinous degeneration, 314 
Fibromata, 318 
Fibrous tissue, 112, 310 
Filth diseases, 140 
Filtration, 198 
Fire damp, 235 
Fissure of Rolando, 69 

Sylvius, 29, 69 
Fistula, 403 

in ano, 351, 352 
Flame, chemistry of, 279 
Fluid extracts, 587 
Fluorine, 230, 301 
Fontanels, 445 
Foods, 73, 75, 76, 83, 87, 98, 108, 

111, 147, 159 
Foramen ovale, 71 
Foramina of skull, 15 
Forceps, use of, 501, 502, 503, 514 
Forests, effect of, 148 
Formulae, 193, 212 
Fowler's solution, 273, 538, 601 
Fractures, 347, 393, 395, 409, 421, 
425, 428, 429 

clavicle, 400 

femur, 373, 380, 421 

forearm, 363 

inferior maxilla, 412 

humerus, 350 

nasal bones, 355 

patella, 379 

Pott's, 340 

ribs, 415 

skull, 343, 347, 349, 378, 
409 
Fruit acids, 256 
Funis, prolapse of, 499 
Furuncle, 387 

Galaetogogue, 599 
Galactorrhea, 497 
Gall bladder, 41 

stones, see Biliary calculi 
Gallic acid, 524, 562 
Galvanic cell, 213 

definition of, 175, 176 
Gamboge, 609 
Gangrene, 313, 318 
Gas, definition of, 200 

illuminating, 214 



Gaseous elements, 240 

Gastralgia, 638 

Gastric juice, 120 

Gastritis, 658 

Gastrocnemius, 12 

Gastro-duodenitis, 542 

Gastrotomy, 398 

Gelsemium, 537, 584, 588, 589 

Genitalia, 352 

Gentian, 587 

Genu valgam, 397 

Germicide, 557 

Germ theory, 149 

Giant cell, 317 

Glands, ductless, 115 
excretory, 132 
of small intestine, 34 

Glauber's salt, 598 

Glaucoma, 424 

Gliomata, 396 

Globulins, 210 

Glottis, edema of, 623 

Glucose, 204, 210 

Glucosides, 563 

Glycerin, 208, 271, 605 

Glycogen, 212 

Gold, 527 

Gonorrhea in obstetrics, 497 

Gossypium, 572 

Gout, 320, 321, 613, 686, 688 

Gravitation, 211 

Groin, 384 

Guaiacum, 580, 589 

Guarana, 556 

Gum arabic, 591 

Gun-cotton, 181, 252 

Gunshot wounds, 377 

Hair follicle, 62 

Halogens, 177, 198, 206 

Hamamelis, 559 

Hammer-toe, 418 

Hamstring muscle, 29 

Hare-lip, 414 

Haversian system, 66 

Hay-fever, 693 

Hearing, organs of, 99 

Heart, arteries of, 30 

apex beat of, 111 
columnae carneae, 133 
description of, 652 
dilatation of, 652 
fatty changes in, 313 • 
hypertrophy of, 312, 652 
palpitation of, 626 



INDEX. 



701 



Heart, rate of, 91, 109 

remedies, 550, 592 

revolution of, 80 

sounds, 120, 125, 645, 661, 
662, 667, 673 

valvular diseases of, 312, 
328, 652, 689 

ventricles of, 11, 16 

weak, training for, 141 
Heating of houses, 147 
Heat production, 114 

prostration, 151, 652 
Hectic fever, 334 
Heel, bones of, 30 
Hematemesis, 620, 688 
Hematics, 560 
Hematocele, 491 
Hematosalpinx, 509 
Hematoxylon, 581 
Hematuria, 680 
Hemoglobin, 92, 187, 257 
Hemophylia, 619 
Hemoptysis, 660, 680 
Hemorrhages, 323, 371, 385, 427 

cerebral, 623, 665, 669 
in obstetrics, 491 
pulmonary, 629 
Hemostatic, 558 
Hemothorax, 642 
Hepatitis, 622 
Hernia, 352, 353, 369, 375, 376, 

386, 388, 398 
Herpes progenitalis, 430 

zoster, 636 
Hiccough, 550 
Hip joint, 45 
Humerus, 12, 18 
Humidity, effect of, 170 
Hunger, 77 

Hydatid pregnancy, 439 
Hydrargyri iodidum rubrum, 574 
Hydrargyrism, 574 
Hydrarygrum cum creta, 573 
Hydrastis, 576 
Hydrate, 203 
Hydrogen, 201, 205, 206, 280 

dioxide, 220, 285, 577 
sulphide, 177, 224, 265 
Hydrobromic acid, 293 
Hydrocarbon, 258 
Hydrocele, 388, 407 
Hydrocephalus, 498, 617, 658 
Hydrochloric acid, 262, 303, 544, 558 
Hydrocyanic acid, 284, 295, 299, 604 
Hydrogogue, 539 



j Hydronephrosis, 684 
i Hydrophobia, 345 
| Hydrosalpinx, 509 

Hydrothorax, 655 
! Hydride, 278 
iHydriodic acid, 293 
! Hygrometer, 264 

Hyoscine, 541, 563, 566 

Hyoscyamus, 541, 571 

Hyperemesis, 449 

Hyperemia, 311, 334 

Hypermetropia, 131 

Hypertrophy, 427 

Hypnotics, 566 

Hypochondriac region, 16, '38 

Hypodermic medication, 521 

Hypodermoclysis, 598 

Hypospadias, 397 

Hypostatic inflammation, 334 

Hysterectomy, 481, 506 

Hysteria, 648 

Ice, artificial, 151 

Ichthyol, 562 

Icterus, 321, 667 

Ileocecal valve, 40, 88 

Illuminating gas, 233 

Immigrant inspection, 168 

Immunity from disease, 136, 307, 309 v 

Incompatibility, 523, 531, 593 

Indian hemp, see Cannabis Indica 

Indiean, 304 

Infant, care of, 475, 477, 478, 500, 

515 
feeding, 154 
Infantile paralysis, 677 
Infarct, 320 
Infectious diseases, 136 
Infiltration, 311 
Inflammation, 314, 316, 318, 321,. 

325, 332, 381, 414, 415, 430 
Inflammatory fever, 372 
Influenza, 660 
Inguinal canal, 26, 30 
Insemination, 436 
Insolation, 616 
Insomnia, 539 
Intercostal neuralgia, 657 
Intermittent fever, 571, 658 
Intervertebral substance, 72 
Intestinal bacteria, 97 

colic, 688 

glands, 34, 113 

indigestion, 571 

obstruction, 383, 419, 633 



702 



INDEX. 



Intestinal villi, 113 
Intestine, large, use of, 125 
Intussusception, 388 
Involution, 473 
Iodine, 237, 537, 541 
Iodism, 576 

Iodoform, 216, 560, 575 
Ions, 300 

Ipicacuanha, 535, 565 
Iris (of eye), 515 
versicolor, 572 
Iron, 276 

compounds of, 176, 179, 217, 
260, 556 

group, 289 

reduced, 270 

tests for, 178 
Ischio-rectal abscess, 339, 377 

fossa, 11 
Isomerism, 209, 226 
Isomorphous, 175, 265 

Jaborandi, 523, 547 
Jalap, 578 ; 589 
Jaw, excision of, 391 
Juniper, 602 

Kidney, 11, 33, 37, 82 

circulation of, 18 

degeneration, 331 
Koumis, 573 
Kousso, 609 
Knee joint, 64, 343 

Labor, delayed, 489 

diagnosis of, 461 

management of, 467, 469, 

470, 471, 472, 473, 477, 

479, 483, 484, 485, 486, 

487, 488, 490, 513, 518 

mechanism of, 462, 463, 464, 

465, 486, 514, 515 
pains, 462 
precipitate, 488 
preparation for, 460, 468, 471 
stages of, 461, 466 
Lachrymal duct, 339 
gland, 64 
Lactic acid, 298, 607 
Lactose, 599 
Lactucarium, 548 
Lanolin, 575 

Lardaceous degeneration, 325 
Laryngismus stridulus, 667 
Larynx, 25 



Larynx, stenosis of, 409 

ventricles of, 27 
Latent heat, 211 
Lateral sinus, 51 
Laws of combination, 203 
Lead, 180, 231, 546 

antidote for, 212 

poisoning, 621 

test for, 222 
Leontiasis ossia, 366 
Leucomaines, 119 
Leukemia, 311, 625, 638 
Lignum vitae, 577 
Lime, 586 

water, 599 
Limonis sulcus, 580 
Linamentum calcis, 578 
Linea alba, 61 
Linum, 576 
Lipomata, 319 
Liquor amnii, 438 
Lithium, 191, 261, 519 
Litholapaxy, 392 
Lithotomy, 419 
Litmus, 200, 229 
Liver, 9, 36, 73, 87, 132 

abscess of, 657 

amyloid, 330 

atrophy of, 324, 336 

cirrhosis of, 614 

hemorrhage of, 340 

hyperemia of, 326 

percussion of, 666 
Lobelia, 519 

Locomotor ataxia, 319, 666 
Lotio hydrargyri flava, 546 
nigra, 556 
Lunar caustic, 176 
Lungs, 37, 64, 132 

gangrene of, 659 
Lupus, 403 
Lymph, 103, 108 
Lymphadenitis, 334 
Lymphangitis, 336 
Lymphatic glands, 10, 69, 71, 325, 
331 
system, 122 
Lymphorrhagia, 323, 325 

Magnesia, 602 
Malaria, hygiene of, 135 
Malleability, 229 
Malleolus, external, 35 
Mammary abscess, 496 

glands, 59, 451 



INDEX. 



'03 



Manganese, 577 

Manure, disposition of, 156 

Marsh's test, 194 

Mastication, 32 

Mastitis, 496 

Materia meclica, definition of, 536 

Maxillary sinus, 48 

Measles, see Kubeola 

Meat inspection, 170 

Meconium, 446 

Mediastinum, 69, 72 

Medulla oblongata, 63, 89 

Meibomian glands, 18 

Melanosarcoma, 309 

Membrana tympani, 344 

Membranes, mucous, serous and 

synovial, 116 
Meniere 's disease, 117 
Meningitis, 309, 633, 653, 659, 664, 

666 
Menopanse, 512 
Menstruation, 434, 435 
Mentha piperita, 574 
Mercury, 193, 266, 595, 596 

chlorides of, 216, 245, 286, 

291, 520, 532, 546 
iodides of, 293 
Metabolism, 75 
Metals, 211 
Methane, 182 

Metric system, 239, 265, 297 
Micturition, 85 
Migraine, 684 
Milium, 406 
Milk, adulteration of, 157 

composition of, 237 

cow's, 186, 291 

diseases conveyed by, 167 

human, 94, 186, 291 

inspection of, 170 

modified, 136 

souring of, 238 

sterilized, 151, 170, 278 
Mineral water, see Water 
Miscarriage, 456 
Mixture, definition of, 240 
Molecule, definition of, 189 
Morbus coxae, 345, 399 
Morphine, 226, 534 
Mortification, 368 
Mouth, hygiene of, 158 
Mucin, 246 

Mucoid degeneration, 311 
Mumps, see Parotitis 
Muscles, 260 



Muscles, abdominal, 10 

affections of, 399 

atrophy of, 672 

biceps, 45 

classes of, 13 

compressor urethrae, 14 

contraction of, 117, 125, 130 

deltoid, 44 

fatigue, 127 

gluteus maximus, 38, 72 

internal oblique, 10 

involuntary, 98 

masseter, 72 

of back, 70 

of calf of leg, 12, 40 

of forearm, 13 

of neck, 51 

of orbit, 14 

of male perineum, 40 

of mastication, 32 

of scapulo-humeral joint, 53 

of tendo achillis, 16 

rectus abdominis, 56 

shoulder and arm, 45 

sphincter ani, 61 

structure, 106 

tibialis anticus, 61, 72 

tissue, 65 

trapezius, 20 

quadriceps, 41, 348 
Myalgia, 646 
Mydriatics, 557 
Myelitis, 630, 662 
Myocardial degeneration, 331 
Myocarditis, 679 
Myomata, 319 
Myopia, 124, 162 
Myotics, 542 
Myxedema, 685 

Narcotics, 611 

Nasal fossae, 54 

Nascent state, 204 

Necrosis, 420 

Negroes, diseases common with, 168 

Nephrectomy, 390, 393 

Nephritis, 314, 315, 329, 565, 622, 

652, 670, 683 
Nephrolithiasis, 619 
Nephrorrhaphy, 390 
Nephrotomy, 390 
Nerves, afferent, 113 

cranial, 23 

efferent, 113 

facial, 47, 92, 356, 401 



704 



INDEX 



Nerves, fibre, 37, 87 

fifth cranial, 26, 33, 66, 111 

fourth cranial, 78 

glossopharyngeal, 39, 60 

median, 29, 341 

motor oculi, 66, 109, 119 

of eye, 65 

of optic commissure, 20 

of palm of hand, 56 

olfactory, 59 

optic, 14, 75 

pharyngeal plexus, 68 

phrenic, 68, 647 

pneumogastric, 50, 57, 95 

radial, 61, 393 

sciatic, 21 

sclerosis of, 324 

sixth, 11, 78 

spinal accessory, 413 

spinal cord, 58 

superior laryngeal, 97 

sympathetic, 43, 85 

ulnar, 398 
Neuralgia of fifth nerve, 400 

prescription for, 550 
Neurasthenia, 637 
Neuritis, 646, 648 
Neuromata, 319 
Nevus, 423 

New-born, hygiene of, 153 
Night-sweats, 525 
Nipples, care of, 495, 496 
Nitrates, 257 

Nitric acid, 190, 215, 236, 592 
Nitrites, 257 
Nitrogen, 272 

acids, 263 

oxides of, 221, 268, 611 
Nitroglycerin, 254, 263, 535, 539 
Nomenclature, chemical, 189, 203, 
210, 224, 226, 227, 268, 277, 292, 
298 
Non-metals, 179, 211 
Normal salt solution, 394 
Nuisances, 154, 166 
Nursing women, hygiene of, 158 
Nux vomica, 522, 567 

Obesity, 100, 133, 337 
Oil of turpentine, 602 

wintergreen, 528 
Ointments, 575 
Oleates, 575 
Olefiant gas, 195 
Oleic acid, 564 



Oleomargarin, 137 
Oleum erigirontis, 606 

morrhuae, 577 

ricini, 600 

sabinae, 606 

theobromatis, 525 

tiglii, 519 
Olfactory apparatus, 123 
Olive oil, 186, 606 
Omentum, 21 
Opium, 185, 416, 532, 544, 547, 554, 

569, 585, 607 
Opthalmia, gonorrheal, 320, 497 
Organic chemistry, 200 
compounds, 176 
Osmosis, 83, 274 
Ossa innominata, 57 
Ostitis deformans, 366 
Ovaralgia, 510 
Ovarian cyst, 511, 516 

dropsy, 654 
Ovaries, 52 
Ovaritis, 510 
Ovule, 437 
Ovulation, 437 
Ovum, 83, 437, 438 
Oxalic acid, 242, 300 
Ox-gall, 589 
Oxygen, 194, 205, 223, 234, 242, 275, 

288, 295 
Ozone, 189, 230, 251 

Paget 's disease, 343 
Pain, 100 
Pallor, 92 
Palmar arch, 36 

' fascia, 53 
Pancreas, 21, 93 
Pancreatin, 573 
Papillomata, 312 
Paracentesis, 386 
Paraciticide, 557 
Paralysis agitans, 629 
Paraphimosis, 349, 397 
Paresis, 321 
Paris green, 249 
Paronychia, 364, 402 
Parotid duct, 10 
Parotitis, 144, 636, 693 
Patellar reflex, 647, 685 
Pelvic inflammation, 510 
Pelvimetry, 517 
Pelvis, bones of, 31 

female,. 439, 440, 441, 442* 

male, 439 



INDEX. 



705 



Pepo, 560 
Pepsin, 251, 573 
Peptones, 210 
Pericardial effusion, 692 
Pericarditis, 633, 641, 650, 663, 690 
Pericardium, 21 
Perineum, 40, 469, 470, 514 
Periosteum, 61 
Periostitis, 646 

Peritonitis, 322, 339, 628, 630, .644 
Peritoneum, 25, 62 
Perspiration, 94, 118 
Pertussis, 144, 613, 629, 634 
Petroleum products, 180 
Peyer's glands, 69 
Pharynx, 30, 39 
Phenacetine, 205, 530, 605 
Phenol, see Carbolic acid 
products of, 272 
Phimosis, 368, 397 
Phlebitis, 307, 404, 426 
Phlegmasia alba dolens, 481 
Phosphorus, 144, 181, 182, 206, 212, 

221, 253, 284, 520, 538, 547, 606 
Photography, 199 
Phthisis, see Tuberculosis 
Physical action, 213 
Physics, 240 

Physostigmine, 531, 537, 603 
Phytolacca, 526 
Pia mater, 44 
Picrotoxin, 595, 598 
Pilocarpine, 528, 544, 567, 580, 591 
Pix liquida, 595 
Placenta, 435, 468, 477 

previa, 492 
Plaster of Paris, 262 
Plastic operations, 409 
Pleura, 30 

Pleurisy, 619, 657, 689 
Pleuritic effusion, 692 
Pleuritis, 657 
Plumbing, 160 
Pneumonia, 316, 618, 644, 655, 665, 

672, 686, 687, 689 
Pneumonitis, 671 
Podophyllin, 601 
Polarization, 175 
Pomegranate, 607 
Pons varolii, 26 
Popliteal space, 64 
Porosity, 254 
Porro 's operation, 506 
Portal circulation, 95 
Post-mortems, 86, 337 

45 



Postpartum hemorrhage, 482 
Potassium, 218, 266 

compounds, 179, 191, 243, 
252, 299, 524, 535, 572, 
590, 591, 600, 606 
Poupart 7 s ligament, 22 
Precipitate, definition of, 240 
Pregnancy, 442, 443, 450 

albuminuria in, 454, 455 
diagnosis of, 447, 448, 

452, 515, 516 
hygiene of, 163, 453 
multiple, 498, 499, 516 
pathology of, 454. 
presentations in, 452, 453, 
463, 464 
Premature birth, 474 
Prescriptions, 531, 534, 
547, 549, 



539, 
550, 
568, 
600, 



541, 
551, 

572, 
602, 



583, 586 
604 

metric, 576, 606, 607 
Preventible diseases, 139 
Productive inflammation, 312 
Prostate, 28 
Prostatectomy, 375 
Prostatitis, 360 
Proteids, 185 
Protoplasm, 116 
Ptomaines, 143, 191 
Ptosis, 428 

Puberty in female, 439 
Puerperal state, 476, 480, 495 

convulsions, 494 
Pulmonary abscess, 649 

edema, 634, 671 
solidification, 664 
sounds, 645, 671, 673, 
677, 690, 691 
Pulsatilla, 556 
Pulse, 79, 93 
Pulvis glycyrrhizae comp., 524, 563 

jalapae comp., 529 
Purgatives, 570 
Purpura hemorrhagica, 689 

simplex, 674 
Pus, 163, 319, 334 
Pustule, malignant, 408 
Putrefaction, 261 
Pyelitis, 629 
Pyemia, 395, 398 
Pyroxylin, 181, 252 
Pyuria, 624 



706 



INDEX. 



Qualitative analysis, 209, 240 

Quantitative analysis, 209 

Quarantine, 148 

Quassia, 556 

Quickening in pregnancy, 449 

Quinine, 596 

Rachitis, 620, 650 
Radical, 179, 253, 275 
Ramus of jaw, 67 
Rattlesnake bite, 425 
Reagent, 174, 203 
Rectal feeding, 102 
Reotocele, 511 
Rectum, 32, 42, 70 

stricture of, 390 
Reflex action, 78, 107, 129 
Reflexes, the, 102 
Remittent fever, 645 
Renal circulation, 95 
colic, 676, 688 
Reserve air, 126 
Residual air, 126 
Resorcin, 581 

Respiration, 81, 89, 124, 128, 156 
Respiratory sounds, 81, 131 
Retina, 107, 116 
Retropharyngeal abscess, 687 
Rheumatism, 536, 593, 646, 648, 654, 

664, 665, 670, 688 
Rhubarb, 598 
Rigor mortis, 85, 117 
Rochelle salt, 598 
Roentgen ray, 265 
Roseola, 644, 674 
Rotheln, 144 
Rubella, 644, 674 
Rubeola, 138, 642, 644, 654, 658, 

674 

Saccharin, 599 

Sacro-iliac disease, 349, 399 

Safety lamps, 250 

Sal ammoniac, 178 

Salicylic acid, 204, 522, 575, 594 

Salivary glands, 17 

Salol, 577, 609 

Salpingitis, 509 

Saltpetre, 607 

Salts, definition of, 173, 203 

Santalum, 581 

Saponification, 109, 287 

Sarcoma, 310 

Sarsaparilla, 592 

Scabies, 552 



Scalp wounds, 344 
Scammonium, 560 
Scarlatina, 162, 316, 631, 644, 663, 

666, 667, 674, 680 
Scarpa's triangle, 33 
School houses, 148 

life, diseases of, 149 
rooms, 157, 161 
Sciatica, 615 
Sclerosis, multiple, 638 
Sooparius, 562 
Scrotum, affections of, 383 
Scurvy, 627 
Sebaceous glands, 89 
Secretion, 89 
Seidlitz powder, 250 
Selenium, 301 
Semen, 436 
Seminal fluid, 121 
Senile changes, 328 
Senna, 543, 586, 605 
Septicemia, 398 
Serpentaria, 564 
Serum therapy, 569 
Sewage disposal, 164 
Sewer gas, 137, 166 
Shock, 410, 420 
Shoulder joint, 19 
Sialagogue, 538, 599 
Sigmoid flexure, 4, 6 
Sinapis, 525 
Sinus, 395 
Sinuses of face, 55 
Skin, 49, 115, 131, 158 
Sleep, 121, 134, 153 
Small-pox, see Variola 
Smell, sense of, 77, 123 
Soap, 270, 300 
Sodium compounds, 529, 544, 555, 

572 
Solar plexus, 15 
Solvent, definition of, 554 
Sound, sensation of, 115 
Sparteine, 529 
Spasms, 687 
Special senses, 100, 117 
Specific gravity, 174, 200, 218, 235, 

240 
Spectroscope, 175 . , 

Speech center, 99 
Spermatic cord, 29 
Spermatozoa, 436 
Sphincter ani, 61 
Sphygmograph, 107 
Spigelia, 573 






INDEX 



707 



Spina bifida, 319 
Spinal column, 38, 49 

cord, 58, 86, 100, 126, 128 

Spleen, 31 

in fevers, 691 

in leucocythemia, 126 

Sprain, 411 

Sputum disinfection, 149 

Squills, 606 

Stammering, 131 

Staphisagria, 549 

Starch, 180 

Static electricity, 176 

Stenson's duct, 36, 90 

Sterility, 456 

Still-birth, 501 

Stoichiometrical problems, 205, 236, 
239, 287, 290 

Stomach, 36 

absorption from, 93 
cancer of, 636, 643 
distension of, 91, 627 
foreign body in, 359 
ulcer of, 620, 643, 647 

Stomatitis, 685 

Strabismus, 394 

Stramonium, 247 

Strophantus, 536, 553 

Strychnine, 258, 278, 534, 564, 579, 
584, 608 

St. Vitus' dance, see Chorea 

Styptic, 558 

Subinvolution, 473, 478 

Sublimination, 176, 214 

Sublingual duct, 10 

Submaxillary duct, 10 

Sudoriferous glands, 89 

Sugar, tests for, 188, 247, 262 
classes of, 195, 215 

Sulphonal, 607 

Sulphur, 194, 214, 234, 255, 282, 
528, 536, 555, 607 

Sulphuretted hydrogen, 236 

Sulphuric acid, 211, 222, 245, 282 

Sulphurous acid, 202 

Sulphur, oxides of, 194, 269 

Sunstroke, 616, 652, 691 

Superfetation, 499 

Suprarenal capsule, 63 

Surgical fever, 347 

Symbiosis, 326 

Sympathetic nerve, 43 

Symphysiotomy, 505 

Synarthrosis, 19 

Syncope, 121 



Synovial bursae, 394 

Synthesis, 258 

Syphilis, 312, 430, 500, 583, 654, 692 

Syphilitic gummata, 324 

Tabes dorsalis, 656 

Talipes calcaneus, 348 

equino -varus, 358, 407 
equinus, 359 

Tallow, 186 

Tampon, 482 

Tannic acid, 571, 597 

Tape worms, 635, 678 

Tar, 551 

Tartar emetic, 219, 236, 557, 559, 
595 

Tartaric acid, 277, 284, 299 

Tea drinking, 167 

Tears, 92, 133 

Teeth, 46, 88, 97, 123, 129 

Tendo Achillis, 16 

Tendons, 14 

Temperature of body, 86, 101, 126, 
127, 130, 663, 673 

Temporo-maxillary articulation, 47 

Testes, 28, 57, 123 

Tetanus, 85, 615, 656 

Therapeutics, definition of, 536 

Thermometers, 228, 232, 264 

Thigh amputation, 374 
Thirst, 77 
Thoracic duct, 30 
Thrombosis, 311, 690 
Thrombus, 426 
Thymol, 551 
Thymus, 63 
Thyroid, 12, 119 
Tic douloureux, 680 
Tidal air, 126 
Tinctures, 582, 587 
Tinnitus aurium, 432 
Tobacco, evils of, 151, 162 
Tongue, 44, 646 

excision of, 339 
Tonsillitis, 649, 682 
Tonsils, 69 
Torticollis, 397 
Trachea, 49 

foreign body in, 357 
Tracheotomy, 68, 346 
Trichinosis, 528 
Tubal pregnancy, 460 
Tubercle bacilli, 315, 328 
Tubercles, 310, 332, 335 
Tubercula quadrigemina, 18 



1 i 



708 



INDEX. 



Tubercular joints, 322, 336 
meningitis, 322 
ulcer, 323 
Tuberculosis, 141, 313, 332, 335, 642, 

648, 672, 686 
Tully's powder, 555 
Tumors, 325, 331, 332, 347, 381, 382, 

383, 402, 405, 424 
Turpentine, 282, 553, 602 
Tympanum, 391 
Typhoid, 165, 333 
Typhoidal ulcer, 323 
Tyrotoxicon, 143 

Ulceration, 327, 368 
Umbilical cord, 439 

hemorrhage, 500 
souffle, 451 
Underwear, material of, 167 
Urates in urine, 278 
Urea, 84, 187, 222, 262, 283, 333 
Uremia, 416, 533, 622, 651 
Ureter, 9, 67 
Urethra, 15, 70 
Urethritis, 343 
Uric acid, 185, 186, 200, 247, 232, 

252, 689 
Urinary calculi, 187, 304 

deposits, 244, 276, 296 
Urination, 127 
Urine, amount of, 198 

composition of, 82, 120, 129, 

183, 192, 218 
examination of, 238 
in health, 117 
in nephritis, 297 
pigments, 247 
pus in, 357 
reaction of, 209 
specific gravity of, 183, 185, 

207, 241, 269, 292 
tube casts in, 310 
Urinometer, 266 
Urticaria, 526 
Uterine bruit, 45 
colic, 688 
fibroid, 516 
hydatids, 439 
inertia, 489 
Uterus, 62, 435, 436, 442, 507 
after pregnancy, 91 
cancer of, 512 
dilatation of, 508 
displacement of, 455, 507 
fixation of, 509 



Uterus, inversion of, 492 

ligaments of, 24 

rupture of, 490 
Uva ursae, 531, 577 

Vaccination, 140, 142, 144, 165, 166, 

170, 657 
Vagina, 19 
Vaginismus, 508 
Vaginitis, 405 
Valence, 253 
Valerian, 578 

Varicella, 144, 649, 651, 674 
Varicocele, 361 
Varicose veins, 432 
Variola, 138, 632, 651, 657 
Varioloid, 662 
Varix, 426 

Vascular system of new-born, 71 
Vaseline, 228 
Vasomotor remedies, 593 
Veins, cerebral, 61 

external jugular, 67 

internal jugular, 32 

pulmonary, 49 

saphenous, 68 

subclavian, 13 
Vena cava, 40, 47 
Venesection, 563 
Venous blood current, 112 
Ventilation, 152, 153, 161 
Veratrum, 530, 543, 602 
Version, 504, 505 
Vertebrae, 14, 35 
Vertigo, 624 
Vesicants, 601 
Vesiculae seminales, 60 
Vienna paste, 556 
Vinegar, 181 
Vitellus, 438 
Vocal cords, 10, 80, 90 
Voice, 112 
Volvulus, 386 
Vomiting, 96, 539, 624 
Vulva, 517 
Vulvo-vaginal abscess, 351 

Water/ 200 

contamination of, 161, 168 
decomposition of, 192, 234 
detection of impurities in, 

164, 247, 273, 301 
diseases conveyed by, 164 
hard and soft, 169 



MAR 151950 



INDEX. 



709 



Water, mineral, 190, 228, 250, 283, 
296 

natural, 230 

of crystallization, 174 

uses of, 545, 578 
Webbed fingers, 422 
Wet pack, 159 

Willow, preparations from, 570 
Willes, circle of, 42 
Wine, adulteration of, 140 
Wolffian bodies, 94 
Wormian bones, 62 



Wounds, classification of, 384 

infection of, 395 
Wrist, amputation, 368 

joint, 31 
Wry-neck, 365 

Yellow-fever, 167, 626, 630, 646 

Zinc, preparations of, 603 

salts of, 179, 207, 252 
Zingiber, 558 



* C 



<w 














^ 



o <> 

# % 








c °^^% £sj^S> £sZ&:S> d>*^ 

^ - ^0* O Willis r ^% \ o jgilll * r ^0 X O ,^11^ - ^ 0^ 



V * x * ° / ■ . ^ \> *. i * o , -^ 




<* 




c 







^> 



^l£^V <^^',V <?^^*% *\ cP%- 




v * v * ° * „ - *%* 











■V ^ 



^ • 




% <** : 



c5> ^ 







; \^ M 














& ^ 




$ q*. .S<z« IW 













^ V 









%4 



w 



^ 







^ 



k * *N 



^ S* o 








z $ °^ >W M?.° & q^ i\ _£ < 



>* 










v % 






\^ 



<£ ^ 

# 










V^\^» 



cP<V 



s N Ay * ■ 




%, 



%.<$ 



£ °- 











•A <1 1> 



ai a, 



V ^> 




Ho, 






y ^ 









•* <r 



Sj> <* *s^ ^ 






A 



V 



,^%> 








■i. -a* 



■%o^ ^o^ 



&°* 



V *. t * ^ ^ 



Q, y « . x 







^0> 

^ ^ 



%.<& «\A%iA\~%^ 



V v s- v ° /• -^v \> • ; * * o « -^> \> „ y * o „ 







1^ ^ 






5 ■ 






# % 






s 
%,♦■ 



^^X'- : ^>->;--nc*^ 










<,^— s A G 




■<P 




3 ^ 



r^ i>^^i 




^ V ^ v * ° 






%^ 




%-o^ 






^3 

5> Q. o 






^0^ 







%^ 






a> ^ o 



•A -^ 



v^r-:V" '/.-..V- '/,.,V- *^,.;; 







iS ^ 




